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HEALTH  PROGEESS  AND  ADMINISTRATION 
IN  THE  WEST  INDIES 


WORKS    BY    THE   SAME    AUTHOR 

A  TEXT-BOOK  OP  MORBID  HISTOLOGY,  1892. 

ANTIMALARIA  MEASURES  AT  ISMAILIA,  1904. 

REPORT  ON  THE  SANITATION  AND  ANTIMALARIA 
MEASURES  IN  BATHURST,  CONAKRY,  AND 
FREETOWN,  1905. 

YELLOW  FEVER  PROPHYLAXIS  IN  NEW  ORLEANS, 

1905. 
REPORT  ON  YELLOW  FEVER  OUTBREAK,  BRITISH 

HONDURAS,  1905. 

MOSQUITO  OR  MAN  ?  1909. 


HEALTH  PROGRESS  AND 

ADMINISTRATION  IN  THE 

WEST  INDIES 

BY  SIE  KUBERT  W.  BOYCE,  M.B.,  F.E.S. 

PBOFESSOB    OF    PATHOLOGY,    UNIVERSITV    OF     LIVEEPOOL  5      DEAN    OF    THE    LIVERPOOL    SCHOOL    OF 

TROPICAL   MEDICINE  ;     BACTERIOLOGIST  TO    THE    CITY   OF   LIVERPOOL  ;     MEMBER   OF   THE 

ROYAL     COMMISSION     ON    TtTBERCULOSIS  ;     COMMANDER    OF    THE    ORDER    OF 

LEOPOLD  II.  ;   FELLOW  OF  UNIVERSITY  COLLEGE,  LONDON,  ETC. 

WITH    ILLUSTRATIONS 

"  Wear  a  smile  on  your  face,  and  a  flower  in  your  buttonhole." 

—The  Password  during  the  New  Orleans  Yellow 
Fever  Epidemic,  1905. 


NEW    YORK 
E.    P.    DUTTON   AND    COMPANY 

1910 


Printed  in  Great  Britain. 


\ 


TO 
THE   RIGHT    HONOURABLE 

JOSEPH    CHAMBERLAIN,    M.P. 

The  Statesman  toho  realised  the  dreams  of  those  %oho,  like  Dr  John 
Davey,  F.R.S.,  o/1849,  hoped  that  the  day  would  come  "when  instruction 
loould  be  given  in  the  diseases  of  the  army  by  competent  teachers  to 
caiididates  for  commissions  in  the  Medical  Department,  by  which  means 
the  attention  of  young  men  might  be  directed  to  enquiry.  Questions,  of 
which  there  are  so  many  unsolved,  might  be  proposed,  and  be  investi- 
gated as  oppoi'tunities  offered  in  their  after  career,  the  solution  of  which 
loould  greatly  advance  msdical  science,  and  would  not  fail  to  improve 
inedical  practice  " 

THIS  SMALL  WORK  ON    SANITARY  PROGRESS  AND  ADMINISTRATION  IN  THE 

WEST    INDIES    IS    INSCRIBED,  BY    ONE    WHO    HAS    FOLLOWED    THE 

TROPICAL  MOVEMENT  SINCE  ITS  INCEPTION 


PREFACE 

This  epitomised  record  of  the  Progress  of  Sanitation 
and  Sanitary  Administration  in  the  West  Indies  is  the 
outcome  of  a  visit  which  I  paid  to  the  West  Indies  at 
the  request  of  the  Right  Hon.  The  Secretary  of  State 
for  the  Colonies  to  Barbados  in  March  1909,  in  order 
to  investigate  an  epidemic  of  Yellow  Fever  which  was 
present  in  the  colony  at  the  time.  Whilst  making 
investigations  into  the  subject  of  yellow  fever  in 
Barbados,  I  was  requested  by  the  Governor  of  the 
Windward  Islands,  and  the  Governors  of  Trinidad 
and  British  Guiana,  to  prolong  my  stay  and  visit  their 
respective  territories,  and  to  report  upon  the  health 
conditions  obtaining  in  these  colonies.  I  gladly  availed 
myself  of  the  excellent  opportunities  held  out  to  me, 
and  I  trust  that  the  narration  of  my  experiences  as 
described  in  the  present  volume  will  be  of  use,  not 
only  to  the  medical  and  business  man,  but  also  to  the 
tourist  who  wishes  either  to  reside  in  or  to  visit  these 
beautiful  colonies.  I  hope  also  that  this  work  will 
serve  as  a  small  introduction  to  the  history  of  yellow 
fever  in  the  West  Indies,  and  that  it  will  encourage 
students  to  travel  in  order  to  investigate  diseases  on 
the  spot. 


viii  PREFACE 

In  investigations  such  as  I  undertook,  everything 
depended  upon  the  vv^illingness  of  the  local  authorities 
to  give  assistance  and  to  co-operate  with  me  in  my 
work.  In  this  volume  I  hope  I  have  given  credit  for 
the  immense  amount  of  kindness,  consideration,  and 
help  which  I  received  upon  all  sides. 

To  the  Governors  and  Administrators  of  each 
colony  I  respectfully  tender  my  sincere  thanks :  they 
invited  me  to  make  my  headquarters  in  Government 
House  in  each  colony ;  they  brought  me  in  contact 
with  all  classes  of  society,  and  in  every  way  made  my 
stay  of  immense  interest  and  profit.  To  my  colleagues 
of  the  medical  profession  I  also  express  my  warm 
thanks  for  the  great  kindness  and  assistance  which 
they  extended  to  me ;  knowing  by  experience  the 
difficulties  which  beset  medical  administration,  I  was 
much  gratified  to  see  everywhere  striking  evidence  of 
sanitary  progress  and  medical  organisation. 

To  the  numerous  other  officials,  many  of  them  old 
friends,  and  to  those  citizens  who  extended  to  me  their 
hospitality,  I  tender  my  thanks. 

To  the  sanitary  inspectors,  who  were  my  constant 
companions,  and  to  the  ministers  of  religion,  who  on 
numerous  occasions  expressed  their  willingness  to  co- 
operate and  place  at  the  service  of  hygiene  their 
splendid  organisation,  I  wish  to  especially  record  my 
warm  appreciation. 

I  also  desire  to  express  my  sincere  thanks  to  Sir 
Owen  Philipps,  K.C.M.G.,  the  Chairman,  Directors, 
and  officers  of  the  Royal  Mail  Steam  Packet  Company, 
who  not  only  generously  franked  my  travelling,  but  in 


PREFACE  ix 

every  way  assisted  to  make  my  journey  pleasurable 
whilst  on  board  their  splendidly  equipped  steamers ;  to 
Sir  Alfred  Jones,  K.C.M.G.,  Chairman  of  the  Liverpool 
School  of  Tropical  Medicine;  and,  finally,  I  wish 
especially  to  thank  my  friend,  Mr  A.  E.  Aspinall, 
Secretary  of  the  West  India  Committee,  for  much 
friendly  advice  and  criticism  during  the  preparation  of 
this  work. 

RUBERT   BOYCE. 

The  University  of  Liverpool, 
January  1910. 


CONTENTS 


CHAP.  PAGE 

I.  Fragments  of  the  Early  History  of  Yellow  Fever  in 

THE  West  Indies     ......         1 

II.  Then  and  Now.  The  Great  Mortality  prom  Yellow 
Fever  and  Other  Diseases  m  the  West  Indies  in 
THE  Eighteenth  and  Nineteenth  Centuries  .  .         6 

III.  The  Old  and  the  Modern  Views  op  the  Nature  and 

Mode  of  Transmission  of  Yellow  Fever        .  .       20 

IV.  Some  of  the  Factors  which  have  made  the  West  Indies 

Healthier.        Pipe-borne      Water-supplies      versus 
Barrels         ...... 


V.  Education   as   a   Prophylactic  Factor   in    the   West 
Indies  ...... 

VI.  The  War  against  Insect  Pests  in  the  West  Indies 

VII.  The   Law   against   Stagnant   Water   in  some  of  the 
West  Indian  Colonies       .... 

VIII.  Trade  Routes  and  the  Extension  of  Disease 

IX.  The  History  of  the  1907-1909  Yellow  Fever  outbreak 
IN  Barbados  ..... 

X.  Health  Progress  and  Administration  in  Barbados 

XI.  Health  Progress  and  Administration  in  Grenada 

XII.  Health  Progress  and  Administration  in  St  Vincent 

Xni.  Health  Progress  and  Administration  in  St  Lucia 

XIV.  Health  Progress  and  Administration  in  Trinidad 


34 

41 
49 

54 

76 

84 
122 
149 
162 
174 
187 


XV.  Health  Progress  and  Administration  in  British  Guiana      228 


xii  [CONTENTS 

PAOI 

Appendices — 

A.  Circulars  and  Reports  relating  to  Ankylostomiasis  in  British 

Guiana  and  in  the  West  Indies        ....      253 

B.  Reports    relating  to  the  Mosquito-carried  Diseases  in  St 

Lucia  ........      264 

C.  Circulars  and  Notices  relating  to  Mosquito  Destruction  and 

Yellow  Fever  in  Barbados    .....      268 

D.  Correspondence  in  Connection  with  the  Question  of  tardy 

notification  of  Yellow  Fever  in  Barbados    .  .  .      284 

E.  Circulars  and  Reports  relating  to  Plague  and  Rat  Destruc- 

tion in  Jamaica,  Grenada,  Trinidad,  and  British  Guiana  .      285 

F.  Eruptive  Fevers,  Atypical  Smallpox,  etc.         .  .  .      290 

G.  Health  Progress  in  the  French  West  Indies,  Martinique,  and 

Guadeloupe     .  .  .  .  .  .  .      292 

//.  Health  Progress  in  the  Republic  of  Cuba  and  in  Porto  Rico  299 

/.  Health  Progress  in  Jamaica       .....  302 

J.  Health  Progress  in  the  Bahamas  and  in  the  Northern  Islands  304 

K.  Health  Progress  in  British  Honduras  ....  305 

Conclusion  .  .  .  .  .  .  .  .311 

Bibliography      .  .  .  .  ,  .  .  .313 

Index       .........      323 


LIST    OF    ILLUSTRATIONS 


1.  View  of  Georgetown,  Demerara 

2.  Stegomyia  calopus      ...... 

3.  Larvae  of  Stegomyia  ...... 

4.  Belleville,  Barbados  ,  .  .  .  .  . 

5.  Plan  of  Bridgetown,  showing  Breeding  Places  of  Stegomyia 

6.  Plan  of  Bridgetown,  showing  Distribution  of  Cases  of 

Yellow  Fever        ..... 

7.  Plan  of  Barbados,  showing  Distribution  of  Yellow  Fever 

Cases  ...... 

8.  An  Emergency  Hospital,  Barbados . 

9.  A  Mosquito-proof  Eoom,  Emergency  Hospital,  Barbados 

10.  House  Inspection,  Bridgetown,  Barbados  . 

11.  Filling  up  Land  with  Odd  Receptacles,  Bridgetown 

12.  Removing  Odd  Water  Receptacles,  Bridgetown,  Barbados 

13.  Plan  of  Bridgetown,  showing  Position  of  Water-taps 

14.  Coast  Scenery  in  Barbados  .... 

15.  Coast  Scenery  in  Barbados  .... 

16.  View  of  Harbour  of  St  George,  Grenada    . 

17.  View  of  Town  of  St  George,  Grenada' 

xiii 


PAGB 

.    Frontisjjiece 


Facing  26 
30 
84 
86 

88 

„  90 

„  110 

»  112 

„  122 

„  124 

„  126 
130 

„  142 

»  144 

»  148 

»  150 


XIV 


LIST  OF  ILLUSTRATIONS 


18.  Plan  of  Town  of  St  George  . 

19.  Kingstown,  St  Vincent,  looking  West 

20.  Kingstown,  St  Vincent,  looking  East 

21.  Plan  of  Kingstown,  St  Vincent 

22.  Town  of  Castries,  St  Lucia  . 

23.  Plan  of  Port  of  Castries,  St  Lucia 

24.  Eoad  in  Port  of  Spain 

25.  Plan  of  Port  of  Spain  and  Suburbs 

26.  Map  showing  Trinidad  and  Venezuela 

27.  A  Large  Concrete  Drain,  Port  of  Spain 

28.  Large  Concrete  Drains,  Port  of  Spain 

29.  Concrete  Roadside  Drain,  Port  of  Spain 

30.  Small  Roadside  Concrete  Drain,  Port  of  Spain 

31.  Large  Concrete  Drain  passing  under  Roadway,  Port  of 

Spain         .... 

32.  Coolie  Ranges,  Trinidad 

33.  Coolie  Ranges,  Usine  Madelaine,  Trinidad 

34.  Interior  of  an  Estates  Hospital,  Trinidad 

35.  View  of  Georgetown,  Demerara 

36.  Plan  of  Georgetown,  Demerara 

37.  A    Large    Central    Ornamental    Canal,     Georgetown 

Demerara  ..... 

38.  A  Side  Trench,  Georgetown,  Demerara 

39.  A  Grass-grown  Side  Trench,  Georgetown  . 

40.  Yards  in  Georgetown,  showing  Wooden  Vats 

41.  Yards  in  Georgetown,  showing  Barrels 

42.  Coolie  Ranges  and  Latrines,  Pin.  Diamond,  Demerara 


Facing  152 
162 
164 
168 
174 
180 
186 
188 
192 
202 
204 
208 
212 


LIST  OF  ILLUSTRATIONS  xv 


PA  OK 


43.  Estates  Hospital,  Pin.  Diamond,  Demerara  .  .     Faciwj  246 

44.  Small  Mosque  for  Coolies,  on  a  Plantation,  Demerara      .  „       250 

45.  Water-holding  and  Mosquito-breeding  Epiphytes  upon  a 

Tree,  Trinidad ,,264 

46.  The  Bamboo  ........       266 

47.  A  Simple  Form  of  Mosquito  Trap  made  out  of  Biscuit 

Tins,  the  Interior  of  which  has  been  blackened  .         „       292 

MAP 

West  Indies  {in  Colour)        ......  1 


HEALTH  PROGRESS  AND  ADMINISTRATION 
IN  THE  WEST  INDIES 

CHAPTER  I 

FRAGMENTS   OF   THE   EARLY   HISTORY    OF   YELLOW   FEVER 
IN   THE   WEST   INDIES 

There  is  a  strong  flavour  of  romance  and  fascination 
about  the  history  of  Yellow  Fever  in  the  West  Indies 
and  on  the  Spanish  Main,  as  about  all  things  attaching 
to  those  parts  of  the  world.  Yellow  fever  was  the 
worst  enemy  which  the  Conquistador es  or  the  Dis- 
coverers of  the  New  World  had  to  encounter.  We 
read  how  it  was  known  to  the  ancient  Mexicans,  and 
of  the  bitter  complaints  of  Columbus  to  his  sovereign 
upon  the  deadly  effect  which  fever  produced  amongst 
his  men.  Indeed  the  mortality  in  the  ranks  of  the 
early  Conquistador  es  in  a  very  large  measure  helped  to 
strip  the  gilt  off  the  gingerbread  of  the  El  Dorados, 
the  "cities  whose  streets  were  paved  with  gold." 

So  bad  indeed  was  it,  that  Spain  could  only  furnish 
supplies  of  men  by  forcible  deportation — a  method 
which  was  later  on  practised  by  Cromwell,  when  after 
the  Irish  Eebellion  he  "gave  Barbados"  to  many  a 
poor  peasant. 

1  A 


2  EARLY  HISTORY 

The  first  recorded  outbreak  of  yellow  fever  in  the 
West  Indies  was  that  which  occuiTed  in  the  city  of 
Isabella,  in  St  Domingo,  at  about  the  time  of  its  founda- 
tion by  Columbus  in  the  year  1493.  Another  epidemic 
is  recorded  at  Capara,  in  Porto  Eico,  in  1508.  Another 
in  St  Pierre,  in  Martinique,  in  1735.  The  fomidation 
of  these  towns  was  heralded  almost  as  a  matter  of 
course  by  an  outbreak  of  yellow  fever. 

Yellow  fever  is  often  regarded  as  a  disease  peculiar 
to  the  Latin  races,  the  explanation,  in  my  opinion, 
being  that  the  Conquistadores  of  old,  the  buccaneers,  and 
the  pirates  of  the  Middle  Ages  were  either  Spaniards  or 
Portuguese.  These  nationalities  were  therefore  the 
first  to  encounter  the  deadly  yellow  fever  mosquito ; 
later,  when  the  French  followed  in  their  train,  they  had 
equally  to  pay  tribute  to  the  Stegomyia ;  and  so  with 
the  Dutch,  and  then  with  the  English,  as  we  shall  see 
in  the  following  chapter. 

In  recent  times  the  Spanish  soldiers  in  Cuba  were 
much  more  harassed  by  yellow  fever  than  by  the  hostile 
natives ;  and  in  the  southern  provinces  of  the  United 
States  the  same  disease  almost  wiped  out  the  Italian 
and  Sicilian  labour  population,  but  only  because  they 
happened  to  form  the  bulk  of  the  labourers  and  lived 
massed  together  in  the  poorer  quarters,  and  were 
surrounded  by  innumerable  water  receptacles,  which 
bred  Stegomyia  in  abundance. 

We  read  that  in  British  Guiana  the  immigration 
from  the  Peninsula  was  discontinued,  because  yellow 
fever  seemed  to  single  out  the  Portuguese  in  prefer- 
ence to  the  other   nationalities.     In   Chapter  XIV., 


"BULAM  FEVER"  3 

devoted  to  British  Guiana,  I  have  attempted  to  explain 
this. 

The  chief  chroniclers  of  the  disastrous  outbreaks  of 
yellow  fever  in  the  Middle  Ages  in  the  West  Indies 
were  the  devoted  monks  who  accompanied  the  Conquis- 
tadores.  To  this  day  the  names  of  Pere  Labat  and 
Pere  Du  Tertre  are  well  known  to  many  in  the  West 
Indies.  Pere  Du  Tertre  (1635),  in  his  Histoire  Generate 
des  Antilles,  appears  to  have  been  the  first  to  describe 
the  progress  of  yellow  fever  in  the  islands ;  he  tells  us 
how  it  was  known  as  coup  de  barre,  owing  to  the 
intense  muscular  pains  which  are  characteristic  of  the 
disease,  and  how  it  attacked  those  clearing  the  land 
and  exposed  to  so-called  poisonous  vapours  and 
exhalations. 

The  better-known  Pere  Labat,  who  landed  in 
Martinique  in  1649,  found  the  disease  raging  amongst 
the  inhabitants  of  that  island,  and  decimating  the  ranks 
of  his  own  order.  The  fever  was  then  known,  he  tells 
us,  as  mal  de  Siam,  because  it  was  thought  that  it 
was  imported  from  Siam  in  the  ship  Orijiamme. 

The  disease  was  also  known  as  "Bulam  Fever," 
because  it  was  thought  that  another  ship,  the  Hankey, 
brought  it  from  West  Africa  to  Grenada.  In  Barbados, 
in  the  year  1691,  yellow  fever  went  by  the  name  of 
Kendal's  Disease. 

One  of  the  most  striking  features  in  the  history  of 
yellow  fever  has  been  the  marvellous  ingenuity  displayed 
by  every  country  to  blame  some  other  part  of  the  globe 
for  giving  the  fever  to  them. 

The    West  Indians,  although  themselves  severely 


4  EARLY  HISTORY 

blamed  for  having  introduced  the  disease  into  Brazil, 
the  United  States  of  America,  Spain  and  Italy,  accused 
in  their  turn,  as  we  have  just  seen,  the  East  (Siam)  and 
Africa  (Bulam)  for  having  given  it  to  them. 

And  even  to-day  the  islands  vie  with  one  another 
in  reproaching  each  other  for  giving  them  the  disease 
should  an  epidemic  unfortunately  arise.  They  are 
exceedingly  touchy  still  upon  the  subject  of  these 
pestilences,  and  will  never  admit  the  parentage  of  the 
fever  if  they  can  help  it. 

"Writers  upon  yellow  fever  of  the  nineteenth  centmy 
have  commented  upon  this  insular  peculiarity.  The 
truth  is,  that  the  reluctance  to  own  up  means,  no  doubt, 
consciousness  of  guilt ;  but  in  the  present  day  it  is  far 
better  to  take  the  attitude  adopted  in  Psalm  xxxviii.  and 
be  absolutely  frank,  for  otherwise  a  reputation  for  con- 
cealment and  of  not  having  the  com-age  to  face  a  calamity 
is  the  inevitable  result.  It  is  a  reputation,  moreover, 
which  undermines  that  which  all  civilised  nations  are 
now  striving  after,  namely,  health- stability  —  more 
precious  than  financial  or  commercial  stability.  Should 
there  be  a  weak  spot  in  the  sanitary  organisation  of  any 
country,  the  policy  of  to-day  is  to  strengthen  it,  and  it 
is  the  only  policy  compatible  with  commercial  progress. 
Concealment,  whether  in  individuals  or  communities, 
leads  invariably  to  the  disease  smouldering  and  spread- 
ing, and  to  an  ultimate  conflagration,  when  the  final 
results  are  infinitely  worse  than  the  expenditure  of  the 
little  firmness  and  moral  courage  necessary  at  the  outset. 

This  has  been  the  invariable  experience  of  large 
communities     when     face    to    face    with     threatened 


YELLOW  FEVER  IN  EUROPE  5 

epidemics.  Boldly  notify  the  first  case,  and  let  the 
sanitary  organisation  be  so  armed  that  implicit  reliance 
can  be  placed  upon  it,  and  in  all  probability  the  first 
case  notified  will  be  also  the  last  one. 

Yellow  fever  was  not  unknown  in  Europe  and  in 
the  United  States.  In  the  sixteenth  and  seventeenth 
centuries  appalling  epidemics  swept  through  whole 
provinces  in  Spain  and  Italy,  and  even  penetrated  to 
France  and  England.  Time  was  also  when  the 
inhabitants  of  Boston,  Baltimore,  and  Philadelphia  were 
regularly  decimated. 

To-day,  however,  all  these  places  are  absolutely 
secure.  In  1905  I  took  part  as  a  volunteer  in  the 
campaign  against  yellow  fever  in  the  city  of  New 
Orleans.  A  few  years  previously  a  similar  and  now 
historic  campaign  had  been  undertaken  in  the  city  of 
Havana,  and  quite  recently  Rio  de  Janeiro  and  Santos 
— all  of  them  cities  of  unenviable  yellow  fever  notoriety 
■ — waged  war  on  the  mosquito,  and  to-day  they  are  as 
secure  as  are  the  cities  of  Boston,  Baltimore,  and 
Philadelphia  from  the  ravages  of  yellow  fever.  The 
beneficial  change  which  has  taken  place  in  the  interval, 
has  made  it  possible  to  confine  yellow  fever  to  a  com- 
paratively small  area — to  so  limit  it,  in  short,  that  we 
are  really  able  to  state  to-day  that  "  yellow  fever  is  a 
dying  disease." 

In  the  following  chapter  I  will  review  the  prevalence 
and  severity  of  yellow  fever  in  the  West  Indies  in  the 
eighteenth  and  nineteenth  centuries,  in  order  that  we 
may  be  in  a  position  to  measure  the  progress  of  sanita- 
tion in  the  West  Indies  during  that  period. 


CHAPTER  II 

THEN  AND  NOW.  THE  GREAT  MORTALITY  FROM  YELLOW 
FEVER  AND  OTHER  DISEASES  IN  THE  WEST  INDIES 
IN   THE   EIGHTEENTH   AND   NINETEENTH   CENTURIES 

By  "  then  "  I  mean  the  eighteenth  century  and  the  first 
half  of  the  nineteenth  century,  at  a  period  in  history 
when  the  West  Indies  were  described  as  the  "  cradle  of 
fever,"  and  had  the  unenviable  notoriety  of  possessing  a 
deadly  fever  of  their  own — a  fever  bred  on  the  spot,  and 
one  which  every  newcomer,  soldier  or  sailor,  merchant, 
official,  or  wife,  was  expected  to  get  before  he  or  she 
was  regarded  as  "acclimatised"  or  "seasoned."  Fever 
was  the  inevitable  gauntlet  that  had  to  be  run  by  all 
new  arrivals,  and  very  few  indeed  escaped,  as  those  of 
us  who  had  parents  or  relations  in  the  West  Indies  in 
those  days  can  testify. 

In  the  engagement  before  Carthagena  in  1741,  under 
Admu-al  Vernon  and  General  Whitworth,  8431  men 
lost  their  lives  by  fever  out  of  a  total  of  12,000. 
In  the  siege  against  Havana,  under  Count  Albemarle, 
in  1762,  a  month  after  landing,  3000  sailors  and  5000 
soldiers  were  down  with  fever.  In  1728  it  was  calcu- 
lated   that    the    English    had    lost    in    their     various 


"WEST  INDIAN"  AND  "SHIPS'"  FEVER  7 

encounters  with  the  Spanish,  by  fever,  2  admirals,  10 
captains,  50  lieutenants,  and  4000  soldiers  and  sailors. 

"Then"  was  the  time  when  "West  Indian  fever" 
regularly  each  year  exacted  a  deadly  toll  of  our 
garrisons ;  when  yellow  fever,  better  known  under  one 
of  its  many  aliases  as  "ships'  fever,"  swooped  down  on 
every  ship,  war  vessel,  and  merchantman.  Those  were 
the  days  which  tried  the  nerve  and  endurance  of  our 
fathers  and  grandparents,  or  at  least  those  of  them  who 
survived  the  deadly  disease  of  not  so  long  ago. 

"Then"  was  also  the  period  when  polluted  well- 
water  was  the  rule,  and  when  in  consequence  cholera, 
mal  (festomac,  typhoid,  and  dysentery  occurred  in  epidemic 
form.  In  those  days  each  island  port  was  often  an 
over-crowded,  drainless,  foul-smelling  collection  of  huts, 
amongst  the  inhabitants  of  which  fever  was  always 
present.  Smallpox,  leprosy,  tetanus,  mal  rouge,  were 
common.  To  give  the  reader  an  idea  of  the  prevalence 
of  fevers  in  the  period  to  which  I  refer,  I  insert  the 
following  tables  and  summaries  of  official  reports  drawn 
up  in  the  early  part  of  the  nineteenth  century. 

As  the  returns  were  made  under  the  headings  of 
intermittent  and  remittent  fevers,  they  included  the 
"seasoning"  and  "acclimatising,"  the  "lowland," 
"marsh,"  "jungle,"  "Jamaica"  and  other  place-named 
fevers — varieties,  no  doubt,  of  malaria  and  yellow  fever, 
for  in  those  days  no  sharp  dividing  line  was  drawn 
between  these  two  diseases,  malaria  and  yellow  fever. 
They  were  both  recognised  to  be  essentially  local  and 
endemic,  and  usually  present  where  miasms  or  emana- 
tions from   decaying,   fermenting,  organic   matter   was 


THEN  AND  NOW 


sure  to  be  found,  as,  for  example,  along  low-lying  coasts, 
in  seaports,  in  towns  and  villages  near  swamps,  in 
valleys,  etc.  The  fevers  were  not  contagious  in  the 
ordinary  sense  :  they  were  not  transmitted  directly  from 
man  to  man  by  contact.  Some  of  them,  yellow  fever 
alone  excepted,  yielded  to  treatment  with  quinine. 

From  the  subjoined  table  it  will  be  seen  how  soon 
and  how  surely  the  newly  arrived  seaman  was  attacked, 
and  with  what  fatality. 


Time  in  Harbour. 

Total  Cases. 

Total  Deaths. 

Centesimal 
Mortality. 

Under  1  week 

1  to    2  weeks 

2  „     4      „ 
4    „      6      „ 
6   „      9      „ 
9   „   12.     „ 

12    „    16      „ 

16  weeks  upwards 

19 
84 
137 
98 
96 
32 
17 
6 

1 

17 
38 
31 

34 
5 
1 
2 

5-2 
20-2 
27-7 
31-6 
35-4 
15-6 

5-8 
23-3 

The  following  figures  are  taken  from  Dr  Browne's 
analyses  of  the  statistical  reports  for  the  army  from  1817 
to  1836. 

In  Jamaica,  for  example,  the  mortality  from  fever 
per  thousand  was  on  the  average  for  20  years  in  the 
following  stations  as  follows  : — 


Montego  Bay 

150-7 

Spanish  Town 

14M 

Port  Antonio 

126-0 

Up  Park  Camp 

121-0 

Port  Royal    . 

93-9 

Falmouth 

80-0 

Stoney  Hill  . 

70-5 

Lucea 

63-2 

Fort  Augusta 

55-5 

Maroon  Town 

15-3 

YELLOW  FEVER  IN  JAMAICA  9 

The  mortality  amongst  the  black  troops  was  only 
about  1  per  cent. 

In  another  table  the  following  figures  are  given  for 
Jamaica  under  the  heading  fevers  : — 

Rate  per  1000  of  mean  strength — 


Admission  into  hospital 
Deaths 


910 
101-9 


Dr  Hunter,  in  his  observations  upon  the  diseases  of 
the  army  in  Jamaica,  states  : — 

Four  regiments  were  sent  from  England  in  1780  ; 
they  arrived  in  Jamaica  on  August  1,  and  by  the  end 
of  the  following  January — that  is,  after  about  six  months 
— nearly  one-half  were  dead,  and  a  considerable  part  of 
the  remainder  unfit  for  service.  The  average  annual 
death-rate  was  about  1  in  4,  and  in  less  than  4  years 
3500  men  had  died,  and  one-half  that  number  had  to  be 
discharged,  making  a  total  loss  to  the  service  of  5250 
men,  and  that,  too,  without  a  single  man  dying  at  the 
hands  of  the  enemy.  ^ 

In  the  Windward  and  Leeward  commands,  the 
mortality  is  given  as  1  in  8  from  remittent  fever.  In  a 
period  of  18  years  the  average  deaths  total  up  to  5320. 

The  following  mean  mortality  rates  for  20  years  also 
tell  their  tale  : — 


Tobago 

104-1  per 

thousand 

St  Vincent 

11-2 

)} 

St  Lucia 

63-1 

>} 

Barbados    . 

11-8 

>} 

Trinidad     . 

61-6 

» 

Antigua 

41-9 

» 

1  Dr  Maunsell  states  that  from  1817-1836  the  annual  death-rate 
amongst  the  troops  was  121-3  per  1000:  and  from  1833-1847  at  the 
rate   of   63'07   per    1000.     A    marked  decrease    then    occurred,    so 


10  THEN  AND  NOW 

These  figures  show  the  local  character  of  the  fevers. 

In  another  part  of  this  report  it  states  that  epidemics 
are  rarely,  if  ever,  absent  from  all  the  islands  in  the 
Windward  command,  and  from  the  stations  in  Jamaica. 
The  conclusion  arrived  at  was  that  the  disease  which 
decimated  the  troops  in  the  West  Indies  was  an  endemic 
disease. 

Again,  it  is  stated  :  "  Fever  causes  five-sixths  of  the 
average  mortality  among  the  troops  in  Jamaica."  In 
addition  to  this  mean  death-rate,  there  were  from  time 
to  time  immense  increases  in  the  death-rate,  caused  by 
recurring  epidemics. 

In  1818  30  per  cent,  of  the  white  troops  died  in 
Trinidad  from  fever. 

In  Tobago  the  mortality  rate  varied  from  13  per 
cent,  in  1818  to  80  per  cent,  in  1820. 

In  Dominica  the  mortality  rate  from  fever  in  the 
year  1817  was  29  per  cent. 

In  Antigua  and  Montserrat,  fever  prevailed  epidemi- 
cally from  1817  to  1836.  Dr  Musgrave  has  described 
the  epidemic  in  Antigua  in  1816,  and  notes  that  it 
attacked  the  newly  arrived  and  spared  the  natives. 

In  St  Kitts,  Tortola,  and  Nevis,  fever  was  often  very 
bad,  especially  yellow  fever. 

In  the  Bahamas  the  mortality  amongst  the  white 
troops  was  thirteen  times  as  great  as  at  home. 

Yellow  fever  is  recorded  in  Martinique  from  1791  to 
1794,  and  again  in  1802  to  1806.  In  1821  and  1825 
epidemics  of  yellow  fever  also  occurred  in  that  island, 

that  from  1880-1889  the  rate  was  11-36  per  1000.     The  chief  cause 
of  mortality  was  fever. 


YELLOW  FEVER  IN  FRENCH  COLONIES  11 

and  686  cases  with  235  deaths  are  reported  from  Port 
Royal  Hospital,  and  96  cases  with  64  deaths  in  the 
Basseterre  Hospital. 

In  1816  and  1821  the  epidemic  visited  Guadeloupe, 
and  475  cases  with  152  deaths  are  recorded  in  the 
Pointe-a-Pitre  Hospital. 

Yellow  fever  at  this  period  also  raged  amongst  the 
ships  of  the  French  navy. 

In  St  Domingo  yellow  fever  is  described  by  Gilbert 
in  1803. 

Dutroulau  describes  the  dysentery  which  was  endemic 
in  Martinique  in  1852. 

So  much  for  the  death-rate  from  miasmatic  fevers  in 
general.  Now  let  us  analyse  the  returns  for  yellow 
fever  alone,  when  this  disease  was  differentiated  from 
the  others. 

Blair,  in  an  account  of  the  yellow  fever  epidemics  of 
Georgetown,  Demerara,  1850,  quotes  as  follows  from  the 
report  of  the  Medical  Inspector  of  the  West  Indian 
Command  for  the  years  1837  to  1841  : — ■''  About  the 
end  of  August  fever  began  to  appear  amongst  the  non- 
commissioned officers  and  privates  :  out  of  32  attacked, 
15  died.  Intermittent  fever  was  at  the  same  time 
very  prevalent ;  1435  cases  came  under  treatment.  In 
Trinidad,  in  May  1838,  fever  occurred  among  the  troops 
at  St  Joseph's ;  15  died  out  of  109  treated ;  a  draft  of 
young  Irishmen,  just  then  arrived,  suffered  most.  In 
Dominica  this  year  (1837),  out  of  65  cases  of  yellow 
fever  admitted  into  the  hospital,  21  died.  Nearly 
all  the  officers  had  the  disease  and  died.  In  this 
epidemic,    haemorrhage    from    the    gums    and     throat 


12  THEN  AND  NOW 

was  common ;  black  vomit  set  in  about  thirteen  hours 
before  death." 

In  Trinidad  (1837),  at  St  Joseph's,  19  men  of  the 
detachment  there  died  of  fever. 

Grenada,  about  the  same  time,  was  severely  visited  by 
fever.  At  Port  Frederick,  out  of  14  men  of  the  Eoyal 
Artillery,  11  were  attacked,  of  whom  6  died.  At 
Eichmond  Hill,  out  of  207  of  the  70th  Kegiment,  61 
were  attacked,  14  died.  Fever  raged  amongst  the  civil 
population,  both  white  and  black  ;  even  the  acclimatised 
by  no  means  escaped  ;  the  crews  of  the  shipping  suffered 
severely. 

In  Barbados  (1837-8),  in  November  and  December, 
yellow  fever  prevailed  amongst  the  inhabitants  of 
Bridgetown  and  proved  very  fatal.  The  troops  were 
then  healthy.  In  the  beginning  of  January  1839  the 
disease  appeared  in  the  52nd  Regiment,  which,  in  the 
November  preceding,  had  arrived  from  Gibraltar ;  of  37 
admitted  into  the  hospital  6  died.  The  officers  of  the  regi- 
ment suffered  in  a  greater  proportion  than  the  men  :  of  10 
attacked  3  died ;  12  were  the  whole  number  in  barracks. 

It  is  remarkable  that  every  individual  who  had  any 
duty  to  perform  requiring  his  presence  in  the  orderly 
room,  which  was  in  the  officers'  barracks  (previously 
considered  healthy),  was  attacked  with  fever ;  and  also 
that  few  escaped  who  occupied  the  adjoining  lower 
rooms.  Thus,  of  24  persons  connected  with  this  part  of 
the  building,  only  2  females  and  4  young  children  escaped 
the  disease.  The  building  was  vacated,  the  floor  taken 
up  but  nothing  offensive  was  found  underneath. 

In  the   quarter   ending   30th  June,   there  was   an 


YELLOW  FEVER  IN  BARBADOS,  ETC.  13 

average  of  39  deaths  out  of  every  123  cases.  The 
inhabitants  at  the  time  were  reported  healthy,  as  also 
the  seamen  and  the  troops  in  Berbice  and  at  the  out- 
stations.    The  weather  was  described  as  particularly  fine. 

In  St  Vincent,  in  the  same  quarter,  yellow  fever  was 
very  destructive  amongst  the  troops :  out  of  310  (the 
total  strength  of  the  white  troops),  241  cases  occurred, 
54  died ;  out  of  18  officers,  the  whole  in  the  garrison, 
9  were  attacked,  4  died. 

In  St  Lucia,  from  the  middle  of  August  to  the  end 
of  September,  the  troops  at  Morne^  Fortune  suffered 
from  fever;  out  of  134  white  troops  93  were  attacked, 
20  died.  The  inhabitants  suffered  even  more  ;  amongst 
the  latter  the  disease  appeared  in  the  early  part  of  July. 
The  weather  was  unusually  dry  and  hot.  About  the 
same  time,  the  fever  was  severe  and  destructive 
amongst  the  inhabitants  of  St  John's,  Antigua.  The 
troops  in  the  island,  however,  escaped  the  disease. 

In  the  quarter  ending  the  31st  December  1839, 
fever  prevailed  amongst  the  troops  in  Barbados ;  it  was 
fatal,  and  chiefly  prevailed  in  the  brick  barracks.  It 
first  appeared  amongst  the  inhabitants  in  the  early  part 
of  October,  and  about  the  end  of  the  month  it  became 
prevalent  in  the  garrison.  The  hospital  sergeant  and 
orderlies  of  the  52nd  Regiment  were  amongst  the  first 
taken  ill ;  then  the  famihes  of  the  married  men ;  then 
the  troops  in  the  barracks.  The  disease  broke  out 
amongst  the  troops  on  the  ships. 

In  Trinidad,  March  1846,  fever  prevailed;  402  cases 
occurred,  13  died. 

1  "  Morne  "  is  a  French  word  equivalent  to  colline  or  hill. 


14 


THEN  AND  NOW 


In  Tobago,  dm-ing  the  same  quarter  of  1846,  62 
were  attacked  with  fever  out  of  71 ;  8  died. 

In  St  Kitts,  out  of  8  attacked,  4  died. 

In  the  same  year  7  fatal  cases  of  fever  occurred 
amongst  the  troops  in  Berbice,  5  in  Trinidad,  24  in  St 
Kitts,  out  of  90  attacked.  In  the  quarter  following,  of 
1840,  at  St  Kitts,  there  were  10  deaths  from  fever  out 
of  33,  in  the  garrison  attacked;  the  civil  population 
suffered  as  well  as  the  troops.  Dm^ing  the  twelve 
months  ending  31st  March,  the  deaths  from  fever  at 
Brimstone  Hill,  St  Kitts,  were  49,  which  was  a  large 
proportion  of  the  garrison. 

In  the  garrison  of  St  Ann's,  Barbados,  an  outbreak 
commenced  in  December  1847,  and  resulted  in  3 
deaths.  In  the  following  January  1848,  21  deaths ;  in 
February,  2  deaths ;  in  March,  4 ;  in  April,  4 ;  in  May, 
1 ;  in  June,  4 ;  in  July,  5 ;  in  August,  6 ;  in  September, 
17 ;  in  October,  13 ;  in  November,  43 ;  in  December, 
30.  In  January  1849,  there  were  5  deaths ;  in  February, 
2;  all  exclusive  of  officers.  A  table  is  also  extant, 
showing  the  prevalence  of  yellow  fever  in  Barbados 
from  1815  to  1846,  and  it  shows  that  yellow  fever  was 
continually  present.  In  another  table  the  percentage  of 
admissions  into  the  military  hospitals  of  Barbados  for 
yellow  fever  are  given  as  follows  : — 


In  1816 

31-79 

„  1820 

41-19 

„  1821 

30-56 

„  1836 

5-26 

„  1838 

28-92 

„  1841 

87-87 

,,  1842 

17-91 

"ABODES  OF  DEATH"  15 

It  is  worthy  of  note  that  there  is  no  record  of 
intermittent  fevers  in  these  entries. 

Blair  drew  attention  to  the  fact  that  the  garrison  of 
St  Ann's,  Barbados,  remsimed  free  from  the  intermittent 
fevers,  as  also  those  of  Brimstone  Hill,  St  Kitts,  and 
Fort  Charlotte  in  St  Vincent,  whilst  they  were  attacked 
by  yellow  fever. 

It  is  recorded  that  shortly  after  the  erection  of  Fort 
Charlotte  near  the  town  of  Nassau,  in  the  Bahamas, 
almost  the  whole  of  the  47th  Regiment,  including  men, 
women,  and  children,  were  swept  off  by  yellow  fever  in 
a  few  weeks ;  this  was  at  the  end  of  the  eighteenth 
century.  In  1802  the  7th  FusiHers  bm^ied  220  men  out 
of  300  in  an  equally  short  period.  In  1803  the  fever 
again  broke  out  and  reduced  the  300  men  to  50 ;  these 
were  saved  by  removal  to  another  spot ;  they,  however, 
later  returned,  and  the  commanding  ofl&cer  and  nearly 
every  man  died.  In  the  year  1818  the  15th  Regiment 
lost  40  men  in  six  months,  and  there  were  many  deaths 
amongst  the  women  and  children,  and,  it  is  added,  not 
a  man  of  the  whole  force  was  fit  for  duty.  No  wonder 
Fort  Charlotte  was  called  the  "Abode  of  Death." 

Of  forty  regiments,  states  the  report,  in  the  Wind- 
ward and  Leeward  Islands,  between  the  years  1816  and 
1848,  only  ten  regiments  were  found  which  had  not 
suffered  from  black  vomit  to  a  greater  or  less  degree. 
None  escaped  in  Jamaica.  In  both  commands,  out  of 
the  fifty-three  regiments,  thirty-three  regiments  were 
attacked  with  black  vomit  within  twelve  months  after 
arrival.  This,  adds  the  report,  shows  pretty  accurately 
that  the  ari^ival  of  the  stranger  at  almost  any  time  or 


16 


THEN  AND  NOW 


season  in  the  West  Indies  was  sufficient  to  develop  yellow 
fever.  Sporadic  cases  were  of  annual  occurrence  in  the 
West  Indies.  In  1805  the  18th  Foot,  soon  after  landing 
in  Barbados,  in  about  three  weeks  lost  110  men  and  7 
officers. 

From  1817  to  1836,  in  the  garrisons  in  Jamaica, 
amounting  at  that  time  to  2578  men,  the  deaths  from 
intermittent  and  remittent  fevers  rose  to  258  men  ;  they 
were  by  far  the  largest  causes  of  the  death-rate  amongst 
the  men. 

At  Mole  St  Nicholas,  St  Domingo,  yellow  fever 
broke  out  amongst  the  newly  arrived  garrison,  and 
1500  soldiers,  the  original  complement  of  the  men, 
perished,  whilst  the  inhabitants  lost  only  30,  of  all  ages. 

Dr  Blair,  in  his  history  of  the  1847  epidemic  of 
yellow  fever  in  British  Guiana,  gives  a  table  showing 
the  deaths  among  the  sailors  in  the  Seamen's  Hospital, 
Georgetown  : — 


In  1836 

12  deal 

„  1837 

.    257   „ 

„  1838 

326   „ 

„  1839 

.    157   „ 

„  1840 

76   „ 

„  1841 

153   „ 

„  1842 

131   „ 

„  1843 

21   „ 

The  deaths  recorded  above  were  no  doubt  largely, 
if  not  entirely,  due  to  yellow  fever.  So  bad  indeed 
became  the  reputation  of  Georgetown,  that  seamen 
could  scarcely  be  induced  upon  any  terms  to  ship  for 
Demerara,  and  of  those  who  did  ship,  many  stated  that 
they  had   been   grossly   deceived,  not  a  few  who  had 


BLAIR  ON  YELLOW  FEVER  IN  DEMERARA       17 

"shipped   for   Norway    finding    themselves    ultimately 
moored  in  the  Demerara  River  !  " 

The  following  is  Blair's  graphic  description  of  the 
land  close  to  the  military  grounds  : — 

There  were  many  hundred  acres  of  jungle,  forming 
a  well- sheltered  swamp  and  a  marsh  of  250  acres,  and 
during  each  high  spring  tide  the  sea  covered  the  surface 
of  the  marsh.  The  soil  was  composed  of  the  usual 
constituents  of  foreshore;  the  surface  was  jagged  by  a 
vast  number  of  half-rotten  stems  and  roots.  The  marsh 
was  tufted  with  a  coarse  grass,  under  whose  half- 
withered  leaves  myriads  of  insects  sheltered.  Innumer- 
able crabs  burrowed  throughout.  Fragments  of  drift- 
wood, bones,  dead  spawn,  dried  mollusca,  and  small  fish 
left  by  the  drift  of  the  tide,  were  scattered  profusely 
over  the  surface.  Near  the  public  roads  were  small 
gullies,  communicating  apparently  with  the  jungle,  lined 
with  cryptogamic  plants  and  containing  frothy,  putrid- 
looking  water.  Within  the  trenches  aquatic  larvse  and 
exuviae  abounded,  and  over  them  clouds  of  mosquitos 
and  sandflies. 

Such  was  the  condition  of  the  neighbourhood  of  the 
military  grounds  during  the  epidemic.  These  particulars 
were  noted  by  Dr  Blair  more  especially  in  1840,  in 
consequence  of  a  reference  being  made  to  him  by  His 
Excellency  the  Governor,  with  a  view  to  reply  to  a 
dispatch  from  the  Right  Hon.  the  Secretary  for  "War, 
regarding  the  question  why  in  a  few  months  69  per 
cent,  of  all  the  white  troops  had  perished ?  "In  close 
proximity  and  to  the  leeward  of  the  marsh  stood  the 
military  hospital.  It  is  said  that  almost  every  case 
admitted  to  the  hospital  during  the  epidemic  developed 
yellow  fever,  no  matter  what  the  ailment  on  admission  ; 


18  '       THEN  AND  NOW 

and  it  ultimately  became  such  a  terror  to  the  soldiers, 
that  the  utmost  difiBculty  was  experienced  in  persuading 
them  to  enter  it  when  sick." 

In  another  passage  Blah'  tells  us,  in  his  description  of 
Georgetown :  "  Over  some  of  the  Stellings,  where  the 
water  is  quiescent,  the  most  oflPensive  smells  arise,  and 
the  ivhite  paint  of  the  wooden  houses  is  speedily  reduced  to 
metallic  lead.'' 

No  wonder  that  in  those  days  our  soldiers  and 
sailors,  brave  fellows  as  they  were,  shuddered  at  the 
thought  of  entering  the  hospitals,  which  were  in  truth 
but  veritable  abodes  of  death. 

I  have  adduced  sufiicient  evidence  to  show  the 
fi'ightful  mortality  which  the  mosquito  wrought  in  those 
days,  whether  it  was  malaria  or  yellow  fever,  and  which 
earned  for  the  West  Indies  an  unenviable  reputation — a 
reputation  so  bad  that  the  Old  and  New  Worlds  regarded 
the  West  Indies  as  the  "cradle  of  fevers,"  the  foci  from 
which  yellow  fever  spread  to  Europe,  the  United  States, 
Central  and  South  America. 

Since  the  days  of  69  per  cent,  mortality  and  the  days 
when,  as  Blair  said,  foul  smells  blackened  white  paint, 
immense  progress  has  been  made. 

Let  all  credit  be  given  to  those  pioneers  of  civilisa- 
tion who  have  to-day  brought  about  the  conditions 
which  I  will  shortly  describe,  and  which  are  surely 
converting  the  West  Indies  into  the  fascinating  health 
resorts  so  well  described  by  Charles  Kingsley,  Sir 
Frederick  Treves,  and  many  others. 

Before  describing  the  measures  which  have  produced 
this   sanitary  revolution,  I  will  devote  the    following 


PURPOSE  OF  FUTURE  PAGES  19 

chapter  to  the  review  of  the  old  opinions  held  about  the 
origin  of  West  Indian  fevers,  and  to  the  modern 
discoveries  of  the  relationship  of  mosquitos  to  disease, 
the  application  of  the  latter  of  which  will  steadily  bring 
about  the  complete  extinction  of  both  malaria  and  yellow 
fever. 


CHAPTER  III 

THE  OLD  AND  THE  MODERN  VIEWS  OF  THE  NATURE 
AND  MODE  OF  TRANSMISSION  OF  YELLOW  FEVER 

An  American  writer,  describing  the  various  theories 
which  have  been  held  in  the  past  about  the  origin  of 
plague,  has  said,  "  there  were  notions  about  original  sin, 
the  wrath  of  God,  comets,  blazing  stars,  flaming  swords 
in  the  sky,  juxtaposition  of  planets,  and  other  mediaeval 
mental  garbage." 

So  with  yellow  fever  in  the  past,  the  theories  have 
been  as  numerous  as  the  medicine  men  of  the  period. 
In  the  West  Indies  the  theory  that  the  Gulf  Stream  was 
the  cause  of  the  fever  has  gained  much  support  from  the 
fact,  doubtless,  that  they  have  always  had  both.^ 

Amongst  the  more  serious  observers,  the  emanations, 
exhalations,  or  miasms  from  marshy  ground,  or  from  any 
fermenting  vegetable  or  animal  matter,  were  regarded  as 
the  great  cause,  but  they  recognised  also  that  something 
additional  was  required,  as  these  emanations  also 
occurred  in  cold  climes  where  there  was  no  yellow  fever, 

1  Almost  all  old  observers  are  agreed  that  the  disease  was  not 

contagious  from  person  to  person,  and  innumerable  experiments  were 

made  to  show  this.     See  Blair,  Dariste,  etc.,  etc.  (Bibliography). 
so 


YELLOW  FEVER  AND  EXHALATIONS  21 

SO  they  argued  that  a  "certain  tropical  temperature,"  or 
"  concatenation  of  circumstances,"  such  as  are  to  be  found 
in  the  tropics,  were  necessary.  "Writers  also  spoke  of 
the  "death  shroud  of  the  Savannas,"  "atmospheric 
envelopes,"  "  segments  of  climate,"  which  were  carried 
by  ships  from  one  country  to  another.  The  atmosphere 
of  the  tropics  was  the  dangerous  element. 

Given  the  exhalations,  the  febrilifying  atmosphere, 
and  a  new  arrival,  yellow  fever  must  break  out. 
Dr  Gilkrest,  in  describing  the  great,  and  at  that  time 
exceedingly  perplexing,  epidemic  of  yellow  fever  in 
Gibraltar,  said  : — "  The  mass  of  those  attacked  merely 
marched  to  their  guardhouses,  to  which  certainly  the 
inhabitants  were  not  in  the  habit  of  resorting,  and 
where  the  soldiers  as  certainly  came  in  contact  with 
no  persons  suffering  from  yellow  fever.  Arrived  at 
his  post  a  soldier  was  placed  at  sentry,  not  in  the 
midst  of  the  dense  population ;  not  with  people  about 
him  from  whom  disease  might  be  transmitted,  nothing 
of  this  occurred.  The  guards  in  charge  of  the  ruins  of 
Pompeii  were  not  in  the  midst  of  a  deeper  solitude 
than  were  often  the  soldiers  of  Gibraltar,  as  they 
inhaled  the  'death  blast'  in  a  district  abandoned  by 
the  inhabitants.  The  men  were  far  removed  from 
contact  with  sick  people,  far  out  of  hearing,  far  out  of 
sight."  But  for  all  that  the  unobserved  mosquito  was 
there. 

Time  and  time  again  the  flooring  of  barracks  and  of 
hospitals  has  been  torn  up  to  try  and  find  out  whence 
came  this  supposed  deadly  miasm,  this  death  blast,  but 
as  often  all  was  found  clean. 


22  OLD  AND  MODERN  VIEWS 

Authorities  at  one  time  concentrated  suspicion  upon 
that  form  of  miasm  which  was  supposed  to  arise  from 
the  mixture,  in  a  marsh  or  on  a  mud  flat,  of  salt  with 
fresh  water.  This  condition  of  affairs  of  course 
happened  in  nearly  all  the  seaport  towns  of  the  West 
Indies,  the  fresh  water  of  the  estuary  met  the  sea,  and 
as  yellow  fever  was  usual  in  all  these  seaports  here 
again  was  cause  and  eff'ect.  Graveyards  were  a  special 
source  of  terror';  so  much  so,  that  bye-laws  were  enacted, 
so  I  am  informed,  to  prevent  new  arrivals  from  visiting 
them.  All  authorities  were  clear  that  yellow  fever  was 
not  contagious  from  person  to  person ;  they  had  not 
hesitated  to  make  direct  experiments  to  test  this,  and 
there  were  the  direct  observations  in  the  hospitals,  that 
neither  the  nm-ses  nor  the  wives  of  the  sick  soldiers 
contracted  it.  So  finally  Fergusson  concludes  in  the 
phraseology  of  the  period  :  "It  is  a  terrestrial  poison 
which  high  atmospheric  heat  generates  amongst  the 
newly  arrived,  and  without  that  heat  it  cannot  exist." 
"  But  rubbish  ! "  says  the  great  and  thoughtful  man, 
Beauperthuy ;  "  the  small  amount  of  sulphuretted 
hydrogen  or  marsh  gas  which  might  arise  from  a  marsh 
could  not  possibly  hurt  a  fly,  much  less  a  man.  It  is  not 
that ;  it  is  a  mosquito  called  in  Cumana  the  '  Zancudo 
bobo,'  the  striped  or  domestic  mosquito."  But  Beau- 
perthuy was  far  ahead  of  his  time,  and  they  did  not 
listen  to  him,  and  they  held  hard  on  to  miasm  aild 
tradition,  as  do  a  few  old  men  still  to  the  present 
day.  Surely,  they  repeated,  it  must  be  a  miasm,  for 
yellow  fever  was  once  a  common  disease  on  ships.  In 
those  days  it  practically  broke  out  on  every  vessel  in 


A  "SEA  MOSQUITC  2g 

the  yellow  fever  zone,  and  what  else  could  have  been 
the  cause,  but  the  foul  smells  or  miasms  from  the  bilge  ? 
The  green  logs  in  the  hold,  or  the  mud,  or  the  gravel, 
or  the  stone  ballast  ?  At  that  period  cargoes  were 
consigned  to  the  deep,  ships  were  scuttled  and  sunk  in 
disgust,  and  when  economy  had  overcome  the  sanitary 
scruples  of  the  owners,  they  were  raised  again — alas  !  to 
be  followed  by  recurrent  outbreaks.  Yes,  it  is  in  the 
shipping  trade  that  the  student  will  find  the  biggest  field 
for  speculation  into  the  origin  of  yellow  fever ;  the  tales 
about  the  sea  serpent  are  hardly  more  wonderful ;  indeed, 
there  is  a  hardy  sceptic  in  Barbados  who  has  written 
quite  recently  that  scientific  men,  in  order  to  explain 
yellow  fever  outbreaks  on  shipboard,  must  prove  the 
existence  of  a  "  sea  mosquito  "  ! 

It  appears  to  me,  however,  that  it  would  be  a  pity  to 
invoke  another  sea  monster,  when  we  have  already  the 
well-known  sea  serpent ;  and  besides,  we  know  very 
well  that  the  wooden  ship  of  old  was  even  more  prone 
to  harbour  and  breed  mosquitos  than  the  house  on  shore  ; 
and  to-day  this  fact  may  be  verified  in  the  case  of  the 
smaller  wooden  craft  which  ply  in  the  estuaries  of  rivers 
in  yellow  fever  countries. 

It  will  not  be  necessary  for  learned  entomologists 
or  doctors  to  discover  the  sea  Stegomyia ;  we  are  content 
to  leave  it  to  the  imagination  of  the  amiable  but  heretical 
doctor  who  invented  the  idea,  just  as  we  do  in  the  case 
of  the  Ancient  Mariner  and  his  sea  serpent. 

For  innumerable  ages  the  miasmatic  or  telluric 
theory  of  the  miasmatic  fevers — yellow  fever  and 
malaria — has  held  sway,  and  therefore  it  is  not  to  be 


24  OLD  AND  MODERN  VIEWS 

wondered  that  the  old  doctrines  die  hard.  But  it  is 
disastrous  if  those  who  ought  to  know  better,  and  who 
are  in  touch  with  books  and  newspapers  and  with 
younger  men,  obstinately  blind  their  eyes  to  the  develop- 
ment which  has  taken  place  since  they  themselves  were 
young.  In  other  words,  it  is  indeed  disastrous  both  to 
individuals  and  to  a  country,  when  the  mind  becomes 
fixed  and  inflexible ;  it  is  the  sign  of  stagnation,  and 
that  the  elasticity  of  youth  has  departed.  Of  course 
there  is  another  class,  which  includes  the  ignorant, 
superstitious,  and  prejudiced,  who  actively  campaign 
against  any  reform,  and  who  are  the  means  of  doing 
incalculable  harm  in  young  communities. 

I  was  informed  of  many  instances  of  this  type  in  the 
"West  Indies — of  how  a  newspaper  in  one  well-known 
and  naturally  beautiful  and  healthy  island,  solemnly 
proclaimed  during  a  smallpox  epidemic  that  the  people 
ran  the  danger  of  their  arms  dropping  ofi"  if  they  were 
vaccinated.  And  in  another  case  how  during  this  same 
smallpox  epidemic,  a  native  parson  warned  his  con- 
gregation that  if  they  were  vaccinated  they  would 
pollute  the  house  of  the  Lord,  and  therefore,  that  they 
should  abstain ;  fortunately  that  same  parson  very 
shortly  afterwards  contracted  smallpox — a  circumstance 
which  no  doubt  changed  his  tune.  I  remember,  in  one 
island,  being  in  a  most  friendly  and  courteous  manner 
interrogated  by  a  member  of  the  local  town  council, 
and  asked  my  opinion  upon  the  merits  of  vaccination. 
I  stated  my  reasons  for  believing  in  the  absolute  efficacy 
of  preventive  inoculation ;  but  my  interrogator  asked 
me   whether   I   was  aware   of  the    contrary   opinions 


«JUJU"  IN  THE  WEST  INDIES  25 

uttered  by  Herbert  Spencer,  Darwin,  W.  G.  Grace, 
Marie  Corelli,  and  some  others.  I  pleaded  that  I 
was  not  aware  of  their  views  upon  the  subject,  and 
that  whatever  opinions  these  learned  people  might 
hold,  it  would  not  alter  my  belief  of  what  I  knew 
to  be  the  unanimous  opinion  of  the  medical  faculty ; 
and  I  put  it  to  my  questioner,  whether,  for  instance,  he 
thought  that  a  large  shipowner  of  Liverpool  would  be 
guided  by  the  above  authorities  on  the  best  form  of 
construction  for  a  cargo  or  passenger  boat  destined  for 
the  North  Atlantic  or  Eastern  traffic. 

These  and  like  views  are,  however,  only  manifesta- 
tions of  insularity  and  ignorance,  and  will  steadily 
disappear  as  education  spreads,  but  nevertheless  they 
are  irritating  and  thwarting  in  times  of  emer- 
gency. 

Of  course,  when  the  press  of  a  colony  takes  this 
attitude,  the  situation  indeed  becomes  almost  hopeless. 
I  am  sorry  to  say  that  this  attitude  has  not  altogether 
died  out,  and  that  the  "juju"  of  Africa  is  still  reflected 
to  a  small  degree  in  the  West  Indies,  But  it  will  go 
as  surely  as  all  those  other  heathen  abominations  have 
gone.  A  much  more  deadly  block  to  progress  is 
encountered  when  the  profession  itself  defends  its 
prejudices  behind  the  ramparts  of  tradition.  In  a  very 
striking  passage  in  his  writings,  the  great  Beauperthuy 
of  Guiana  said  :  "  How  many  centuries  did  it  take  the 
medical  profession  to  break  with  tradition  and  pre- 
conceived classifications  and  causes  of  disease,  and  to 
acknowledge  that  the  common  skin  disease,  the  itch, 
was   communicated   by  a   parasite ? "     "It  took  them 


26  OLD  AND  MODERN  VIEWS 

three  centuries,"  he  adds,  and  "that,  too,  in  spite  of  the 
fact  that  the  poor  negro  was  well  aware  of  its  parasitic 
nature  !  "  With  the  exception  of  Beauperthuy,  Finlay, 
Harrison,  Sutton  Moxly,  Nott,  Carter,  and  a  few  others, 
doctors  gave  up  speculating  upon  the  origin  of  yellow 
fever,  and  resigned  themselves  to  the  inevitable,  and 
spoke  of  "death  blasts,"  "abodes  of  death,"  "yellow 
fever  houses,"  "yellow  fever  envelopes,"  "sections  of 
yellow  fever  climate,"  and  "the  something"  which  the 
new  arrival  in  a  tropical  country  carried  with  him, 
which,  when  it  came  in  contact  with  the  new  conditions 
of  tropical  life,  caused  a  veritable  yellow  fever  explosion. 
The  day  of  deliverance  was  near  at  hand,  however,  and 
it  came  when  Manson,  Ross,  Reed,  Carroll,  Agramonte 
and  Lazear  and  their  numerous  co-workers  and 
followers  proved  that  mosquitos  conveyed  the  marsh 
or  miasmatic  and  other  fevers — malaria,  yellow  fever, 
filaria,  etc.  Then,  as  if  by  magic,  that  which  before 
was  mysterious  and  inexplicable  became  as  daylight. 
The  ubiquitous,  water-loving,  man-following  mosquitos 
were,  of  course,  the  obvious  agents  which  transmitted 
the  disease.  This  fact  was  not  proved  by  one  or  two 
individuals ;  now  every  student  of  tropical  medicine 
verifies  it  for  himself  in  the  schools.  The  mosquito 
transmission  of  disease  is  an  absolute  doctrine.  But 
were  further  proof  necessary,  it  has  been  furnished  in 
overwhelming  mass,  by  the  magnificent  results  which 
have  been  obtained  all  over  the  world  in  preventing 
these  diseases  by  relying  solely  on  antimosquito 
measures.  I  have  already,  in  my  work  on  Mosquito  or 
Man  f  fully  recorded  these  campaigns  against  insect  life, 


>    ^ 


THE  BASIS  OF  YELLOW  FEVER,  PROPHYLAXIS     27 

and  for  further  information  upon  the  subject  I  would 
refer  the  reader  to  it. 

The  Scientijic  Data  about  Yellow  Fever,  upon  which 
Modern  Prophylaxis  is  based. — Yellow  fever  is  caused 
by  a  specific  virus,  the  natui^e  of  which  is  still 
undiscovered.  In  the  last  few  years  much  attention 
has  been  directed  to  find  out  if  possible  the  nature  of 
the  virus,  and  various  protozoa-like  bodies  have  been 
from  time  to  time  described.  Recently  a  spirochsete 
has  been  identified  in  the  tissues  in  cases  of  yellow 
fever. 

During  the  first  three  days  of  the  attack,  during 
which  time  the  patient  is  capable  of  transmitting  the 
infection  to  the  Stegomyia,  the  serum  is  also  infective ; 
before  or  after  these  first  three  days  of  illness,  the 
serum  is  said  not  to  be  infective.  It  is  stated  that 
serum  taken  from  a  patient  dm'ing  the  infective  period 
will  produce  infection  in  a  healthy  subject. 

On  the  other  hand,  evidence  points  to  the  conclusion 
that  neither  the  cadaver,  the  secretions,  nor  the  black 
vomit  are  infective.  These  are  all  points,  however,  the 
final  solution  of  which  awaits  the  definite  discovery  of 
the  real  nature  of  the  parasite  of  the  disease. 

For  prophylaxis,  however,  the  data  are  sufficient 
and  very  precise,  and,  acted  upon,  yield  unerring  results. 
They  are  as  follows  : — Whatever  the  nature  of  the  virus, 
it  is  transmitted  only  by  the  Stegomyia  calopus. 

Incubation  Period  in  Man. — The  period  of  incubation 
in  man — that  is,  the  time  elapsing  after  a  person  has 
been  bitten  by  an  infected  mosquito,  until  the  onset  of 
symptoms — ^is,  approximately^,  five  days. 


28  OLD  AND  MODERN  VIEWS 

After  the  incubation  period,  and  during  the  first 
three  days  of  the  attack,  the  patient  is  capable  of 
transmitting  infection  to  the  Stegomyia,  but  not  at 
other  times  during  the  illness. 

The  Extrinsic  Incubation  Period. — When  the  Stego- 
myia  has  taken  a  meal  of  blood  from  a  yellow  fever 
patient  during  the  three  days  the  patient  is  infective,  it 
is  not  capable  of  immediately  transmitting  the  infection — 
that  is  to  say,  it  does  not  itself  become  infective  until 
after  the  lapse  of  some  12  days,  and  this  is  known  as 
the  extrinsic  incubation  period.  After  this  incubation 
period  it  is  capable  of  transmitting  the  disease  if  it 
bites  a  healthy  person. 

This  power  of  transmitting  infection  persists  in  the 
mosquito  for  many  weeks. 

The  bite  of  a  single  infected  mosquito  suffices  to 
give  an  attack  of  yellow  fever. 

During  the  cold  season,  although  the  mosquitos  may 
not  be  active  and  bite,  they  may  remain  quiescent  in 
some  parts  of  the  house,  and  upon  the  advent  of  warm 
weather,  become  active,  and,  if  infected  in  the  previous 
year,  be  capable  of  transmitting  infection  and  starting  a 
fresh  epidemic.  These  facts  explain  the  persistence  of 
yellow  fever  in  the  so-called  yellow  fever  houses,  and 
also  the  imperative  necessity  for  thorough  fumigation 
in  order  to  destroy  all  infected  mosquitos.  Neglect 
of  this  precaution  invariably  leads  to  recrudescence 
of  the  fever  after  the  outbreak  appears  to  have 
ceased. 

Our  knowledge  as  to  how  far  the  eggs  and  larvae  of 
infected  mosquitos  are  themselves  infected  or  not  and 


THE  STEGOMYIA  C A  LOP  US  29 

are  capable  of  transmitting  infection  to  the  imago,  is  not 
by  any  means  complete  or  precise.  There  is,  however, 
the  possibility  of  transmission  of  the  infection  to  the 
brood,  and  this  constitutes  a  further  argument  for 
making  every  endeavour  to  destroy  the  infected  mos- 
quito and  to  get  rid  of  all  breeding  places. 

Our  knowledge  of  the  carrier  of  yellow  fever,  the 
Stegomyia  calopus,  is  now  very  complete. 

In  the  first  place,  this  mosquito  has  been  proved  to 
be  the  sole  carrier  of  the  disease.  No  infection  is 
carried  by  the  clothes  or  the  bedding  of  the  patient. 

The  Stegomyia  calopus  is  common  in  seaports,  but 
extends  into  inland  towns  following  the  trade  routes. 

It  is  essentially  a  town  dweller,  and  is  the  common 
*' domestic  "  or  "house  mosquito."  It  is  not  known  to 
be  a  marsh  or  swamp  dweller. 

It  is  also  known  as  the  "tiger"  or  "Scots  Grey" 
mosquito. 

It  breeds  in  the  clean  water  receptacles  in  the  yards 
of  houses,  and  it  is,  in  consequence,  often  known  as  the 
"cistern  mosquito."  The  actively  moving  " wrigglers " 
or  "  wiggle-waggles "  which  are  found  in  great  abund- 
ance in  cisterns,  barrels,  and  kerosene  tins  used  for  the 
storage  of  water,  constitute  the  larval  stage  of  the 
mosquito. 

There  is  an  erroneous  opinion  that  mosquito  larvse 
purify  water  by  feeding  upon  pathogenic  bacteria ;  there 
is  no  evidence  to  support  this  contention.^ 

1  To  test  the  point  I  have  made  a  series  of  counting  experiments 
by  plate  culture,  and  I  find  that  larv'se  largely  increase  the  number  of 
bacteria  in  water,  as  indeed  one  would  expect. 


30  OLD  AND  MODERN  VIEWS 

It  also  breeds  in  old  bottles,  meat  and  condensed- 
milk  tins,  flower  pots,  conch  shells,  and  discarded 
receptacles  of  all  kinds  capable  of  holding  water  for  a 
few  days,  which  are  commonly  found  in  all  badly 
kept  yards  and  rubbish  heaps.  It  also  breeds  in  rain- 
water which  may  collect  in  canoes,  in  the  lily  tubs,  and 
the  larvae  may  even  make  their  appearance  in  the  water- 
vessels  and  flower  vases  in  the  rooms  if  the  water  is 
allowed  to  remain  undisturbed  in  them  for  a  few  days. 

Larvae  are  not  usually  found  in  gutters,  pools,  or 
wells,  but,  if  debarred  access  to  the  common  water 
receptacles,  the  mosquito  may  be  driven  to  seek  unusual 
breeding  places. 

It  must  be  remembered  that  if  this  mosquito  is 
found  in  a  house,  its  breeding  place  is  usually  close  at 
hand. 

Because  of  the  fact  that  the  Stegomyia  is  a  cistern 
breeder,  yellow  fever  may  occur  in  the  wealthier  and 
more  sanitary  parts  of  the  town  as  well  as  in  the  poorer 
insanitary  districts. 

It  is  readily  distinguished  from  other  mosquitos  by 
its  very  characteristic  appearance.  It  is  a  "  black  and 
white  mosquito."  There  is  a  lyre-shaped  pattern  in 
white  on  the  back  of  the  thorax,  transverse  white  bands 
on  the  abdomen,  and  white  spots  on  the  sides  of  the 
thorax ;  while  the  legs  have  white  bands  with  the  last 
hind  tarsal  joint  also  white. 

The  mosquito  deposits  its  eggs  on  the  water  in  the 
cistern.  The  eggs  develop  in  from  ten  to  twenty  hours 
into  the  active  wriggling  larvae.  The  larval  or  wiggle 
stage  lasts  one-half  to  eight  days,  and  is  then  followed 


2  P 


RESISTANCE  OF  STEGOMYIA  LARV^  31 

by  the  pupa  stage  ;  from  the  pupa,  in  two  days'  time  or 
even  less,  a  complete  mosquito  emerges  and  flies  into  the 
nearest  house. 

The  eggs  are  resistant  and  capable  of  preserving 
their  vitality  although  removed  from  water  for  some  ten 
to  ninety  days.  They  may  therefore  persist  for  a  long 
period  in  an  empty  damp  barrel,  and  develop  into 
wrigglers  when  the  barrel  is  filled. 

The  larvae  die  in  a  short  time  if  removed  from 
water ;  merely  emptying  water  out  of  a  barrel  or  other 
receptacle  which  contains  wrigglers  will  not  necessarily 
get  rid  of  them,  as  they  cling  to  the  crevices,  and 
reappear  when  fresh  water  is  poured  in.  In  the  same 
way,  heavy  rains  do  not  wash  them  out,  as  erroneously 
supposed.  Careful  screening  is  the  only  effective 
remedy  to  keep  out  the  mosquito,  or,  still  better  of  course, 
the  abolition  of  the  water  barrels  and  odd  receptacles. 

As  the  Stegomyia  may  seek  refuge  for  breeding 
purposes  in  the  shallow  street  drains  and  wells  in  the 
town,  these  must  on  no  account  be  overlooked.  The 
shallow  street  drains  and  pools  should  either  be  filled  in 
or  kept  well  treated  with  crude  petroleum  oils. 

Wells  can  with  difficulty  be  properly  protected,  and 
should  be  filled  in  or  constantly  oiled.  Lily  tubs  and 
ornamental  ponds  should  be  stocked  with  fish. 

The  Stegomyia  mosquito  attacks  its  victim  noiselessly 
and  persistently,  both  during  the  daytime  and  at  night. 
Therefore  it  is  necessary  : — 

1.  To  sleep  always    under  a  properly  made  and 
securely  tucked-in  mosquito  net,  of  a  gauge  of 


32  OLD  AND  MODERN  VIEWS 

18  meshes  to  the  inch.  The  net  should  always 
be  tucked-in  under  the  mattress  and  not  hang 
on  the  floor.  There  should  be  no  slit  in  the 
sides  and  no  holes.  Care  should  be  taken  that 
the  arms  and  legs  are  not  bitten  during  sleep, 
through  coming  in  contact  with  the  net. 

2.  To  screen  where   possible  in   mosquito-infected 

districts  one  living  room,  a  portion  or  whole 
of  the  verandah,  or  the  whole  house.  (Sleep- 
ing in  the  afternoon  without  a  net  is  as 
dangerous  as  sleeping  at  night  without  one.) 

3.  To  remember,  as  the  mosquito  avoids  currents  of 

air,  the  freer  the  through-draft  of  air  the  better. 

The  essential  Guiding  Principle  in  Prophylactic 
Measures  against  all  Mosquito  and  Insect-home  Diseases. 
— The  more  practical  experience  one  gains  of  all 
insect-borne  diseases — that  is,  of  diseases  which  require 
two  hosts  :  man  and  an  insect — the  more  one  comes  to 
the  absolute  conclusion  that  the  bed-rock  principle  of 
efficient  prevention  is  the  extermination  ot  the  insect ; 
this  is  a  final  and  an  irresistible  plan  of  attack ;  other 
methods,  such  as  isolation,  screening,  and  medication 
are  only  palliative.  It  is  with  the  greatest  satisfaction 
that  I  notice  that  H.  K.  Carter,  the  well-known  yellow 
fever  authority  and  director  of  the  hospitals  on  the 
Isthmian  Canal  zone,  has  come  to  the  same  conclusion. 
It  was  with  the  object  of  the  total  extermination  of  the 
Stegomyia,  that  I  worked  whilst  in  British  Honduras 
in  1905,  and  recently  (1909)  in  the  West  Indies. 
Moreover,   I   find    that  medical    and    public   opinion, 


DRAINAGE,  THE  RADICAL  CURE  33 

wherever  I  have  been,  is  on  the  whole  in  favour  of  the 
radical  measure  rather  than,  say,  the  administration  of 
drugs  like  quinine.  For  it  is  rightly  agreed  that  the 
getting  rid  of  stagnant  water  is  beneficial  from  every 
point  of  view,  and  that  the  destruction  of  mosquitos 
will  probably  free  the  world  of  other  diseases  besides 
malaria,  yellow  fever,  and  filaria.  In  addition,  animals 
are  also  protected  as  well  as  man. 

Lastly,  this  radical  measure — i.e.,  drainage — has  had 
the  benefit  of  many  centuries  of  trial,  and  we  all  know 
what  it  has  accomplished  and  how  malaria  and  yellow 
fever  have  been  driven  out  of  countries  where  once 
they  were  prevalent,  without  the  aid  of  a  bottle  of 
medicine.  Therefore  I  say  again,  stagnati07i  is  the  great 
enemy  of  life,  and  all  our  energies  must  be  directed  to 
ridding  the  inhabitable  world  of  it. 


CHAPTER  IV 

SOME    OF     THE    FORCES    WHICH     HAVE    MADE     THE    WEST 
INDIES    HEALTHIER.        PIPE  -  BORNE    WATER  -  SUPPLIES 

versus  barrels 

"Why  have  malaria,  yellow  fever,  cholera,  and  many 
other  pestilences  decreased  or  died  out  in  the  West 
Indies  ?  The  answer  is  :  Civilisation,  with  its  attend- 
ant reforms,  amongst  which  stand  out  education  and 
hygiene  :  these  have  produced  the  beneficial  change. 

The  West  Indies  have  not  stood  still  whilst  the 
rest  of  the  civilised  world  was  progressing;  they  too 
have  undoubtedly  advanced.  The  date  when  modern 
systems  of  sewage  disposal  and  pipe-borne  water-supplies 
were  introduced  and  the  wells  superseded,  marks  the 
dawn  of  practical  hygienic  reform  in  those  islands. 
The  introduction  of  these  modern  improvements  has 
saved  countless  lives,  and  has  been  largely  instrumental 
in  arresting  many  diseases  which  formerly  ravaged  the 
Antilles.  Cholera  and  dysentery  are  no  longer  terrors, 
and  the  conditions  which  obtained  when  the  dead 
were  literally  left  to  bury  their  dead  will  probably 
never  again  recur.  To-day  a  wholesome  non-polluted 
water-supply  is  the  rule,  and  moreover,  it  is  brought  to 

34 


WATER-SUPPLY  REFORM  35 

the  houses  or  laid  to  standpipes  at  convenient  places 
along  the  country  roads.  This  is  truly  the  greatest 
blessing  of  modern  sanitation,  for  it  has  caused  the 
disappearance  of  cholera. 

With  equal  truth  we  can  say  also  that  the  reason 
why  yellow  fever  is  no  longer  endemic  in  Barbados, 
Trinidad,  and  the  other  islands,  is  that  the  new  system 
of  pipe-borne  water  has  done  away  with  the  necessity 
for  storing  rain-water ;  in  consequence,  barrels,  cisterns, 
and  odd  water  receptacles  of  all  descriptions  have  been 
largely  done  away  with.  The  householder  can  draw 
water  from  the  tap  whenever  necessary;  there  is 
therefore  no  longer  the  need  to  store  a  pint  of  water 
for  domestic  use.  This  reform,  of  course,  struck  at  the 
root  of  yellow  fever,  for  it  was  in  the  barrels  and  in  the 
innumerable  other  containers  that  the  yellow  fever 
mosquito — the  Stegomyia — bred.  Hence,  in  the  days 
before  water-supply  reform,  the  Stegomyia  swarmed  in 
the  houses  in  the  seaports,  and  there  is  good  reason  to 
beheve  that  the  Stegomyia  in  those  days  were  always  in 
an  infected  condition,  continually  taking  up  the  poison 
from  mild,  unrecognised  cases,  much  in  the  same 
manner  as  the  Anophelines  do  the  parasites  of  mild 
cases  of  malaria  or  fever  amongst  the  indigenous 
inhabitants.  It  was  owing  to  the  presence  of  these 
infected  mosquitos  that  if  the  non-immune — that  is  to 
say,  the  new  arrival  from  Europe — went  into  an 
inhabited  district,  he  was  sure  to  get  yellow  fever;  it 
was  the  rule,  as  already  observed,  with  the  soldiers  and 
sailors  of  those  days. 

We  have  seen  that  tradition  and  custom  die  hard : 


36  CAUSES  OF  IMPROVEMENT 

it  is  difficult  entirely  to  pull  up  the  finer  roots  of 
OheaJdsm,  and  it  is  still  quite  common  to  encounter 
barrels  around  the  water  tap,  in  the  yard,  and  all  kinds 
of  receptacles  in  which  the  inhabitants  dearly  love  to 
store  their  water,  in  spite  of  the  fact  that  they  can  get  it 
from  the  pipe  whenever  they  want.  The  result  (is,  that 
the  water  stagnates  and  the  Stegomyia  breeds,  and  that 
every  now  and  then  we  read  of  a  little  epidemic  of 
yellow  fever.  This  is,  however,  the  transition  period, 
and,  as  we  shall  subsequently  see,  owing  to  the  enforce- 
ment of  wise  antimosquito  measures  throughout  the  West 
Indies,  we  have  every  reason  to  believe  that  the  last 
strongholds  of  the  Stegomyia  will  be  destroyed  utterly, 
and  that  the  day  is  fast  approaching  when  yellow  fever 
will  be  only  remembered  in  these  islands  as  a  nightmare 
of  the  past. 

By  means  of  better  building  bye-laws  and  the  increase 
of  wealth,  the  old-fashioned  port  towns  have  extended, 
and  beautiful  avenues  are  now  abundant.  A  large 
proportion  of  the  old  overcrowded  rookeries  have  been 
done  away  with.  The  storm  water  is  collected  in 
well-made  stone  or  concrete  drains,  and  land  has  here 
and  there  been  reclaimed.  This  has  brought  about  with 
it  the  drainage  of  the  subsoil  water,  and  the  consequent 
drying  of  the  soil ;  there  is  therefore  less  tendency  for 
pools  to  form  in  wet  weather. 

In  the  days  of  old  it  was  in  these  rain-water  pools  that 
the  Anophelines  bred ;  since  they  have  been  done  away 
with,  there  are  now  fewer  breeding  grounds,  and  there  is 
no  doubt  that  the  towns  in  the  "West  Indies  are  in  con- 
sequence becoming  much  freer  from  indigenous  malaria. 


SANITARY  REFORMS  37 

Malaria  has  been  driven  out  of  the  towns,  and  now 
only  lingers  in  the  valleys  or  villages,  out  of  which  it  is 
hoped,  before  long,  it  will  in  turn  be  chased.  The 
sanitary  reform  now  taking  place  in  the  West  Indies  is 
precisely  what  took  place  in  the  United  States  and  many 
parts  of  Europe  a  century  or  two  ago,  when  malaria  was 
common  in  places  where  now  it  has  long  since  been 
forgotten. 

Again,  the  dust  contractor  has  been  busy,  the  in- 
numerable old  tins  and  broken  receptacles  of  all  kinds 
peculiar  to  tropical  towns  are  being  gathered  up  from 
the  yards  and  buried.  Clean-up  Guilds  have  even  been 
formed,  as,  for  example,  in  Antigua  in  1904,  and  in 
Barbados  during  my  recent  visit  this  year.  It  was 
exhilarating  to  see  the  children  vying  with  one 
another  in  gathering  up  the  rubbish  and  putting  it 
on  the  roadside  for  the  carts.  As  is  well  known, 
it  is  in  these  discarded  milk,  sardine,  and  fruit  tins, 
jars,  pots,  etc.,  etc.,  that  rain-water  is  liable  to 
collect  and  mosquitos  to  breed,  hence  with  their 
removal  a  vast  volume  of  the  mosquito  breeding 
grounds  will  go  also,  and  the  towns  will  be  healthier 
in  proportion. 

I  was  much  impressed  during  my  inspection  of  the 
islands  by  the  natural  cleanliness  and  decency  of  the 
native  inhabitants ;  in  my  daily  wanderings  in  and  out 
of  their  houses  and  yards,  whether  in  the  towns  or 
in  the  scattered  villages,  I  never  encountered  offensive 
sights  or  smells,  such  as  are  unfortunately  only  too 
frequently  met  with  in  many  parts  of  Europe.  Indeed, 
this  natm-al  desire  on  the  part  of  the  inhabitants  to  help 


38  CAUSES  OF  IMPROVEMENT 

themselves,  gave  the  relish  to  doing  all  in  one's  power  to 
help  still  further  to  clean  up. 

The  factors  which  have  brought  about  this  improve- 
ment in  public  decency  has  been  the  appointment  of 
sanitary  inspectors  and  general  medical  supervision,  the 
civilising  influences  of  the  churches,  and  the  schoolmasters. 
The  elements  of  Hygiene,  and  especially  that  form 
directly  applicable  to  the  tropics  and  tropical  diseases, 
are  now  more  systematically  taught  in  the  elementary 
schools,  more  public  lectures  are  given,  and  in  many 
ways  the  health  crusade  is  preached,  and  not  least  by  the 
intelligent  sympathy  and  encouragement  given  by  the 
two  great  and  honoured  Chm^ches  in  the  West  Indies. 

A  feature  in  the  islands  which  I  visited,  and  I  have 
reason  to  believe  a  feature  which  is  universal  through- 
out the  West  Indies,  which  struck  me  with  admiration, 
was  the  magnificent  provision  for  the  sick  and  infirm 
and  the  mentally  afflicted.  Too  much  praise  cannot  be 
bestowed  upon  these  admirable  humane  and  civilising 
institutions.  My  only  lament  was  that  our  medical 
students  in  England  do  not  come  over  and  see  these 
institutions,  and  spend  some  months  studying  the 
tropical  aspect  of  medicine.  I  felt  that  it  would  be  a 
revelation  to  them,  and  would  be  the  first  step  towards 
making  them  what  Mr  Chamberlain  dreamt  of,  namely, 
medical  men,  not  only  of  Great  Britain,  but  of  the  vast 
British  Empire,  equally  equipped  to  treat  the  sick  in  an 
English  country  village,  or  in  some  far  remote,  half- 
civilised  and  distant  province  of  the  great  Empire. 

I  fervently  hope  that  the  time  will  come  when  the 
medical  student's  training  will  not  be  deemed  complete 


COLONIAL  HOSPITALS  AND  NURSING  39 

until  he  has  gained  a  practical  knowledge  of  the  other 
diseases  of  our  globe,  in  which  the  British  have  such  a 
large  holding.  In  my  opinion,  the  awakening  and 
broadening  of  mind  which  such  travelled  students 
would  obtain,  would  be  of  far  more  practical  use  to 
them,  and  of  a  more  stimulating  nature,  than  a  large 
proportion  of  the  so-called  scientific  training,  or  rather 
smattering,  which  they  receive  in  the  botanic,  zoo- 
logical, and  other  laboratories  in  the  present-day 
university.  The  colonial  hospital  of  to-day  in  the 
West  Indies  is  a  reflection  of  all  that  is  best  in  the  best 
equipped  hospitals  of  Europe.  Simpler  perhaps, 
because  the  inmates  are  simple  folk,  but  equally 
efficient.  The  latest  Listerian  principles  of  surgery  and 
midwifery  are,  of  course,  adopted,  and  the  nursing  is, 
as  a  rule,  excellent. 

If  an  example  is  wanted  of  true  devotion  to  the 
alleviation  of  suffering,  let  the  enquirer  pay  a  visit  to 
one  of  the  well-ordered  hygienic  lazarettos  where  the 
leper  is  cared  for.  It  may  be  that  the  lazaretto  visited 
is  nursed  by  some  exiled  French  Roman  Catholic  Sister- 
hood :  if  it  is  so,  the  visitor  will  soon  realise  that  what  is 
France's  loss  is  our  gain,  and  will  wonder  that  a  nation 
could  have  dreamt  that  such  cultured,  intelligent,  and 
devoted  women  could  be  supposed  to  do  any  country 
harm.  However,  the  British  sense  of  freedom  and  live- 
and-let-live  policy  will,  I  hope,  for  many  a  year 
continue  to  welcome  them  to  these  beautiful  islands, 
where  they  will  still  find  plenty  of  useful  fields  to 
work  in. 

I  have  now  written  enough  to  show  that  there  has 


40  CAUSES  OF  IIMPROVEMENT 

been  a  steady  growth  in  health  organisation  in  the 
islands  which  I  visited,  and  for  which  the  authorities 
are  entitled  to  great  praise. 

I  will  therefore  proceed  to  analyse  the  prospects  of 
the  complete  conquest  of  man  over  the  insect  pest  in  the 
West  Indies,  a  conquest  which  would  render  these 
islands  as  healthy  and  disease  free  as  they  are  already 
beautiful  and  naturally  favoured.  In  the  next  chapter 
the  reader  will  judge  whether  West  Indian  society  is 
ready  for  the  complete  conquest. 


CHAPTER  V 

EDUCATION   AS   A   PROPHYLACTIC   FACTOR   IN  THE 
WEST   INDIES 

As  a  firm  believer  in  the  necessity  of  education  in  all 
matters  relating  to  health,  I  seized  the  opportunity, 
wherever  I  went,  of  addressing  the  following  bodies 
systematically,  namely : — 

1.  The  medical  profession. 

2.  Sanitary  inspectors. 

3.  Members  of  Town  Councils  or  Boards  of  Health. 

4.  Schoolmasters  and  mistresses. 

5.  Members     of    the     clerical    profession,    of    all 

denominations. 

6.  Legislative  Councils. 

7.  Members  of  the  Chambers  of  Commerce. 

8.  Representatives  of  the  Press. 

9.  The    public,    through    the    medium   of   popular 

lantern  lectures. 

In  this  way,  I  soon  get  to  know  how  far  the 
principles  of  the  modern  doctrines  of  sanitation  and 
mosquito  destruction  have  taken  root  amongst  the 
various  classes  of  society.    I  am  sometimes  disappointed 


42  EDUCATION  AS  A  FACTOR 

at  the  kind  of  questions  put  to  me,  but,  on  the 
other  hand,  I  am  as  often  agreeably  surprised  at  the 
advanced  knowledge  represented  by  some  of  the  ques- 
tions asked.  There  is  no  doubt  that  health  primers 
are  much  more  frequently  used  in  the  schools.  These 
elementary  health  books  are  of  a  modern  type,  such,  for 
example,  as  those  of  Prout  and  Dixon,  which  explain 
the  dangers  of  mosquitos.  Diagrams  relating  to 
malaria  and  yellow  fever  are  also  prominently  hung  up 
in  the  schools,  police  stations,  and  other  public  places. 
In  some  colonies  systematic  instruction  is  given  to  those 
training  to  become  sanitary  inspectors.  A  lot  more, 
however,  requires  to  be  done.  Medical  men,  school- 
masters, and  clergymen  are  beginning  to  come  out 
and  to  help  in  the  instruction  of  the  public  in  this  great 
organised  endeawur  against  disease.  But  not  half 
enough  of  this  useful  missionary  work  is  done. 

Wherever  I  have  gone,  I  have  always  appealed  to 
the  clergy  of  all  denominations  to  assist  in  the  crusade. 
The  clergy  have  the  ears  and  sympathy  of  the  people, 
and  they  have  the  churches  and  schoolrooms.  More- 
over, during  my  visit  to  New  Orleans  in  the  yellow 
fever  epidemic  of  1905,  I  had  personal  experience 
of  what  can  be  done  by  them.  In  that  trying  time, 
pulpits  were  gladly  given  up  to  teaching  the  doctrine  of 
cleanliness,  obedience  to  the  laws  of  sanitation,  and  to 
the  teachings  of  those  who  were  spreading  the  true 
knowledge  of  the  danger  of  mosquitos. 

Directions  as  to  what  was  best  to  be  done  were 
often  issued  from  the  pulpit.  I  can  write  from  personal 
knowledge,  for  I  gave  short  addresses  myself  in  a  very 


CLERICAL  CO-OPERATION  43 

large  number  of  churches  belonging  to  as  many  sects. 
In  all  the  colonies  which  I  visited  in  this  recent  tour,  I 
found  the  clergy  anxious  to  assist.  In  Trinidad  especi- 
ally, both  the  Eoman  CathoKc  and  Protestant  clergy 
were  exceedingly  sympathetic  and  desirous  to  help  in 
every  way.  As  showing  how  important  other  nations 
regard  the  co-operation  of  the  clergy,  I  reproduce  the 
text  of  some  appeals  issued  during  times  of  epidemics. 
The  first  is  one  issued  to  the  clergy  of  New  Orleans 
during  the  1905  epidemic.      It  runs  as  follows  : — 

Appeal  to  the  Clergy. 

New  Orleans,  La.,  Jvly  29,  1905. 

To  THE  Reverend  Clergy, — The  influence  of  the 
Reverend  Clergy  is  such,  and  their  loyalty  and  public 
spirit  have  been  so  often  demonstrated,  that  we  venture 
to  ask  your  co-operation  with  the  Citizens'  Volunteer 
Organisations  in  the  present  emergency. 

United  action  produces  the  surest  results. 

We  beg  to  ask  that  you  will  speak  to  your  con- 
gregations on  Sunday,  July  30,  or  at  the  earliest 
thereafter  convenient  to  yourself,  in  behalf  of  the  work 
now  being  carried  on  by  the  health  authorities  of  the 
city. 

We  ask  that  you  will  urge  them,  whether  they 
believe  in  the  "  mosquito  theory  "  or  not,  that  they  will 
give  their  hearty  assistance  to  the  authorities,  who  are 
attempting  to  stamp  out  the  mosquito,  or  at  least  one 
source  of  infection.  Urge  upon  them  the  patriotic  duty 
of  allowing  cisterns  to  be  oiled  and  screened,  cesspools 
to  be  treated  with  disinfectants,  etc. 

Many  householders  (a  small  minority,  but  still 
enough  to  work  mischief)  refuse  permission  to  the  oilers 
and  screeners  to  do  the  work.  This  refusal  nullifies  to 
a  great  extent  the  work  accomplished  on  the  premises 


44  EDUCATION  AS  A  FACTOR 

of  willing  householders.  In  previous  visitations  of  the 
fever  we  have  been  fighting  in  the  dark,  striking  at  an 
unknown  enemy  coming  from  a  mysterious  source. 

The  consensus  of  scientific  opinion  fixes  upon  the 
mosquito  as  the  agent  of  transmission  of  the  yellow  fever. 

The  enemy  therefore  is  in  sight.  So  far  as  your 
power  extends,  then,  we  beg  of  you  to  use  it  for  the 
spread  of  information  concerning  the  mosquito  theory, 
and  to  use  your  influence  with  your  congregations  to 
hold  up  the  hands  of  the  constituted  health 
authorities. 

This  office  will  gladly  receive  suggestions,  and  will 
give  all  possible  assistance  to  the  ward  organisations. 

It  is  proposed  to  have  two  cleaning-up  days  by 
proclamation  of  the  Mayor,  although  this  has  not  at  this 
writing  been  definitely  decided.  The  daily  newspapers 
will  announce  it  when  determined. 

We  will  ask  you  to  bring  this  matter  also  to  the 
attention  of  your  congregations.  \ 

Similarly,  during  the  1909  epidemic  of  plague  in  San 
Francisco  a  committee  of  clergy  met  in  the  Chamber  of 
Commerce  to  take  steps  to  advance  a  sanitary  crusade  ; 
representatives  of  all  denominations  met,  and  it  was 
agreed  to  recommend  : — 

1.  That  every  minister  of  a  congregation,  according 
to  his  own  judgment,  present  from  his  pulpit  to  his 
people  the  necessity  of  continuing  their  efforts  in  pro- 
moting the  sanitation  of  San  Francisco,  by  careful 
examination  of  their  own  premises  and  by  recommend- 
ing the  same  thing  to  their  neighbours. 

2.  That  a  recommendation  be  made  to  the  super- 
intendents of  Sabbath  Schools  by  their  pastors,  to 
incorporate  a  short  talk  on  sanitation  in  their  addresses 
to  the  Sunday  School  assemblies. 


EDUCATION  A  PROPHYLACTIC  FACTOR  45 

3.  That  as  far  as  practicable,  mass  meetings  be 
organised  in  the  various  churches,  for  the  purpose  of 
presenting  public  discussions  on  the  subject  of  sanita- 
tion in  general  and  the  issue  now  before  the  people  in 
particular. 

The  churches  themselves  started  by  showing  an 
example  to  the  people  by  proceeding  at  once  to  disinfect 
their  cushions,  carpets,  etc.,  and  to  cleanse  carefully  all 
floors. 

The  representative  of  the  Roman  Catholic  Arch- 
bishop stated  that  a  letter  had  been  sent  to  every 
Catholic  church  in  the  diocese,  directing  the  pastors  to 
discuss  the  official  notices,  which  were  read  in  all  the 
Catholic  chm'ches.  There  is  no  doubt  that  the  clergy 
can  do  a  very  great  amount  to  disseminate  accurate 
knowledge  upon  health  matters  and  how  to  avoid 
disease.  They  have  still  a  great  field  in  the  West 
Indies;  they  have  already  begun  well,  and  I  do 
hope  they  will  persevere,  and  that  the  various  colonial 
Governments  will  supply  them  with  the  necessary 
literature  for  this  good  work. 

Dr  John  Guiteras  of  Havana,  in  writing  upon  the 
subject  of  "Education  as  a  Prophylactic  Factor,"  says  : — 

The  education  of  the  public  in  the  subject  of 
yellow  fever  will  so  guide  public  opinion  that  it  will  be 
possible  to  practically  eliminate  the  transmitting  factor 
of  the  disease,  the  mosquito — the  Stegomyia  calopus. 
...  A  campaign  against  this  mosquito  must  be  a 
general  one,  and  also  include  those  responsible  for  the 
transmission  of  malaria,  filaria,  etc.,  thus  removing 
from  the  tropics  and  sub-tropics  some  of  the  most 
important  causes  of  morbidity  and  mortality,  and  which 


46  EDUCATION  AS  A  FACTOR 

therefore  have  been  serious  obstacles  to  their  political, 
commercial,  and  industrial  progress.  Education  on  this 
subject,  therefore,  I  consider  of  prime  importance  in 
the  prophylaxis  of  yellow  fever,  and  it  is  surprising 
how  little  has  been  done,  or  is  being  done  in  this 
line. 

The  same  feeling,  I  confess,  has  often  struck  me  also, 
especially  with  regard  to  my  own  profession.  In  these 
matters,  I  hold  that  the  medical  profession  ought  to  lead  ; 
in  my  opinion,  they  would  certainly  enhance  and  con- 
solidate their  position  in  the  community  if  they  would 
step  forward  and  organise  lectures  and  demonstrations. 
The  people  are  ripe  for  sanitary  reform,  and  now  want 
leaders.  Medical  men  have  a  great  opportunity,  for  it 
is  a  winning  fight. 

In  his  report  to  the  Surgeon -General  of  the  Public 
Health  Service  of  the  United  States,  a  writer,  who  had 
been  on  yellow  fever  duty,  said  insistent  and  continued 
effort  should  be  made,  through  the  public  press  and 
other  available  means,  to  educate  the  people  within  the 
sphere  of  influence  of  the  Stegomyia  calopus,  so  that 
they  will  learn  to  protect  themselves  against  the  invasion 
or  spread  of  yellow  fever,  by  protecting  themselves 
against  the  mosquito.  Above  all,  to  eradicate  the  existing 
fear  in  the  medical  profession,  as  well  as  among  the  laity, 
of  declaring  the  presence  of  yellow  fever. 

If  the  first  case  presenting  the  slightest  suspicion  of 
that  disease  were  promptly  made  public  and  the  proper 
modern  precautions  taken,  there  would  be  no  danger  of 
the  disease  spreading.  In  fact,  the  public  should  be 
taught  to  acknowledge  the  existence  of  yellow  fever  in 


GUITERAS  ON  EDUCATION  47 

their  midst  with  the  same  equanimity  as  they  do  in  the 
case  of  measles  or  scarlatina. 

Guiteras  goes  on  to  say :  "  I  believe,  and  would 
recommend,  that  the  method  of  transmission  of  yellow 
fever  and  malaria  should  be  taught  in  the  schools 
wherever  these  diseases  are  liable  to  occur.  The  subject 
should  be  taught  in  the  primary  grades,  for  what 
children  then  learn  they  will  retain.  "With  these  ideas 
disseminated,  it  would  not  be  long  before  public  opinion 
would  demand  with  irresistible  force  the  drainage  of 
swamps  and  lowlands,  and  the  inspection  of  houses  and 
premises,  to  see  that  they  were  free  of  breeding  places 
for  mosquitos."  These  are  the  opinions  of  practical 
men,  and  they  are  re-echoed  by  all  those  who  are  engaged 
upon  the  subject  of  health  reform.  In  this  respect  the 
British  nation  is  singularly  backward  in  some  of  its 
dominions :  for  example,  in  India,  where  there  still 
exists  an  appalling  sickness  and  mortality  rate.  The 
West  Indies,  Cuba,  the  Philippines,  Brazil,  Mexico, 
Africa,  have  all  started  forward  on  a  gigantic  health 
crusade.     India  alone  appears  paralysed. 

In  Trinidad  I  found  that  great  attention  had  been 
paid  to  instruction  about  mosquitos  and  their  danger  ; 
and  a  pupil  in  one  of  the  schools  at  which  I  was  giving 
an  address  showed  me  in  her  note-book  some  excellent 
studies  of  mosquito  larvae  which  she  had  made. 
Altogether,  I  formed  a  most  favourable  impression  of 
the  work  of  the  Education  Department  in  that  colony, 
and  it  is  a  good  thing,  for  Trinidad  is  placed  in  a  veiy 
important  and  exacting  position.  It  is  the  connecting- 
link  between  the  Spanish  Main  and  the  West  Indies, 


48  EDUCATION  AS  A  FACTOR 

and  is  in  consequence  singularly  exposed  to  imported 
infection,  either  yellow  fever  or  plague,  especially  the 
latter  disease ;  and  the  education  of  the  public  and  the 
diffusion  of  knowledge  about  the  two  diseases  will  be 
the  best  safeguard  against  these  diseases. 

The  colony  will  save  money  in  the  long  run  by  still 
further  perfecting  and  increasing  its  educational  system. 


CHAPTER  VI 

THE   WAR   AGAINST   INSECT   PESTS   IN   THE   WEST   INDIES 

Following  upon  the  magnificent  examples  of  the 
cleansing  of  Havana  and  the  regenerating  of  the 
Republic  of  Cuba,  and  the  establishment  of  absolute 
health  security  amongst  the  vast  labour  population 
upon  the  Isthmian  Canal  zone,  the  "West  Indian 
authorities  woke  up  also,  and  from  1904  there  has 
been  a  steadily  progressive  policy  of  extermination 
waged  against  the  Stegomyia.  In  most  of  the  islands 
there  exist  wise  antilarval  measures,  which  make  it  an 
offence  to  keep  stagnant  water — that  is,  to  keep  water 
breeding  or  liable  to  breed  mosquito  larvae.  Moreover, 
fines  are  now  regularly  enforced  for  breach  of  this  bye- 
law.  A  policy  of  this  kind  is  bound  to  bear  fruit,  as  it 
has  already  done  in  New  Orleans,  Cuba,  Panama, 
Brazil,  Mexico,  etc.,  etc.,  and  will,  I  am  convinced,  bring 
about  the  total  eradication  of  yellow  fever.  Such  a  policy 
will,  moreover,  have  a  most  desirable  educational  effect, 
and  will  show  the  people  the  significance  and  danger  of 
insect  life,  and  that  in  practice  it  is  not  so  difficult  as 
at  first  sight  might  be  imagined,  to  exterminate  it. 
For  instance,  it  will  encourage  the  inhabitants  to  attack 

49  D 


50  THE  WAR  AGAINST  INSECTS 

in  earnest  the  problem  of  malaria,  for  this  disease  still 
holds  on  in  an  undesirable  manner,  and  it  will  need  a 
concerted  and  well- organised  campaign  to  get  rid  of  the 
Anophelines. 

As  already  a  beginning  has  been  made,  let  us  hope 
that  the  campaign  will  be  now  pushed  still  more 
vigorously  forward.  So  also  with  plague,  it  has  been 
proved  beyond  suspicion  of  a  doubt  that  the  rat  and  its 
flea  spread  plague,  just  as  the  Stegomyia  spreads  yellow 
fever  and  the  Anophelines  malaria.  If  anyone  doubts 
the  rat  and  flea  theory,  let  him  read  the  "  Eradication  of 
the  Plague  in  San  Francisco,"  published  by  the  Health 
Committee  of  that  city — a  committee,  let  it  be  noted, 
which  was  not  composed  of  sentimentalists  or  theorists, 
but  of  hard-headed  business  men,  who  took  action 
because  it  yielded  profit  and  made  their  city  new,  and 
brought  increased  business.  I  therefore  ask  the 
business  men  throughout  the  West  Indies  to  follow  as 
closely  as  they  can  the  practical  experience  of  business 
men  in  other  parts  of  the  world,  and  I  feel  convinced 
that  they  will  never  regret  the  lead,  but  that  on  the 
contrary  they  will  reap  a  rich  return.  Malaria,  yellow 
fever,  and  plague  are  not  the  only  wars  in  which  the 
West  Indies  will  have  to  engage ;  there  are  the  diseases 
like  Filariasis,  known  under  the  names  of  "Barbados 
Leg,"  "Fever  and  Ague,"  "Rose,"  etc.,  also  Dengue  Fever. 
These  require  exterminating  equally  with  other  diseases. 
As  they  are  mosquito-borne,  the  campaign  against 
stagnant  water  will  accomplish  it.  Then  there  is  a 
disease  belonging  to  another  class  of  parasitic  affections, 
known  as  ankylostomiasis,  which  is  receiving  consider- 


SOIL  POLLUTION  51 

able  attention  in  very  many  parts  of  the  tropical  world, 
and  especially  in  the  West  Indies,  where  it  strikes  at 
the  root  of  the  labour  question.  This  parasitic  disease 
is  spread,  not  through  the  agency  of  mosquitos  or  other 
insects,  but  by  man  himself.  Man  pollutes  the  soil,  or 
the  water,  and  his  own  species  become  infected  either 
through  drinking  the  polluted  water  or  through  the  bare 
skin  of  the  feet  from  the  polluted  soil ;  so  the  disease 
makes  headway  until  it  becomes  a  matter  of  serious 
concern  to  governments ;  for  not  only  does  the  disease 
produce  a  considerable  amount  of  suflFering  in  the 
individual  attacked,  and  therefore  lead  to  a  considerable 
loss  of  working  time  and  expenditure  for  treatment,  but 
far  more  serious  even  than  that — owing  to  the  anaemia 
which  it  induces,  it  lowers  the  resisting  power  of  the 
body  to  other  diseases  ;  it  makes,  in  other  words,  the 
system  more  vulnerable  to  all  the  other  diseases  to 
which  man  is  liable.  It  thus  comes  about  that  ankylos- 
tomiasis (tropical  anaemia  or  hook-worm  disease)  is  one 
of  the  most  potent  factors  in  swelling  the  mortality  and 
sickness  returns  in  the  tropics.  Civilised  governments 
have  paid  very  special  attention  to  it,  and  reports  deal- 
ing with  the  subject  have  been  drawn  up  by  the  health 
authorities  in  the  Philippines  and  in  Porto  Eico.  The 
plan  of  attack  is  simple — namely,  the  rigorous  prevention 
of  the  pollution  of  soil  or  water,  by  the  use  of  properly 
constructed  latrines,  and  the  internal  administration  of 
an  intestinal  disinfectant,  such  as  thymol,  to  kill  and 
drive  out  the  parasites  from  the  intestines.  The  matter 
is  also  receiving  the  careful  attention  of  the  medical 
authorities  in  the  West  Indies,  and  regulations  have 


52  THE  WAR  AGAINST  INSECTS 

been  drawn  up  and  every  care  taken  to  diminish  the 
disease.  The  disease  can  be  conquered,  just  as  cholera 
has  been :  man's  carelessness  and  ignorance  are  alone 
to  blame  for  it. 

I  have  brought  forward  sufiBcient  indications  to 
show  that  in  the  war  against  diseases,  the  West  Indies 
are  accomplishing  much ;  but  they  must  not  rest  until 
they  have  completely  chased  out  of  their  midst  all  of 
them.  Having  gone  so  far,  with  such  marked  beneficial 
results,  they  must  proceed  to  the  conclusion,  and  so 
make  their  natm'ally  favoured  islands  not  only  above 
reproach,  but  an  example  to  the  rest  of  the  tropical 
world,  and  India  in  particular,  of  what  can  be  done  by 
courage  and  perseverance.  And  sm'ely  islands  in  which 
almost  every  hill,  rock,  and  bay  is  linked  in  the  mind  with 
the  daring  deeds  of  our  heroic  forefathers,  should  find  no 
difficulty  in  conquering  disease,  and  to  be  in  a  position 
to  say:  "Yes,  our  streets  were  once  strewn  with  the 
dead  and  dying — men  struck  down  on  the  threshold  of 
life  by  the  insignificant  but  intensely  poisonous  mosquito  ; 
but  to-day,  thanks  to  the  knowledge  we  have  gained, 
we  have  absolutely  put  an  end  to  this  wanton  slaughter, 
and  we  can  now  say  that  our  mortality  and  sickness 
rates  are  as  low  as  they  are  in  Europe,  nay,  even  lower, 
and  om'  islands  must  now  be  regarded  as  the  sanatoria 
of  both  the  Old  and  New  Worlds. 

The  insect  pests,  against  which  war  is  being  waged, 
may  be  divided  into  the  following  groups  : — 

I.  MosQUiTos. — {a)  The  Stegomyia,  the  yellow  fever 
transmitting  mosquito,  which  breeds  in  and 
immediately    around    houses,    in    all    artificial 


CLASSIFICATION  OF  INSECT  PESTS  53 

collections  of  water,  such  as  barrels,  cisterns, 
tins,  pots,  vases,  calabashes,  broken  bottles,  etc., 
etc.  (b)  The  Anophelines,  the  malaria  trans- 
mitting mosquitos,  which  breed  in  earth  pools, 
grass-grown  drains,  stagnant  ponds,  marshes, 
trenches,  canals,  in  receptacles  coated  with 
humus,  and  certain  water-holding  plants,  (c) 
The  Culicidce,  which  transmit  dengue  fever, 
and  Jilariasis.  They  breed  in  gutters  and 
wherever  water  stagnates  and  becomes  foul. 

II.  Fleas. — Fleas,  which  convey  plague  and  live  on 

rats  and  men,  and  therefore  to  be  found  where- 
ever  there  are  foul  drains,  or  rubbish  is  allowed 
to  accumulate,  or  where  overcrowding  occurs 
and  the  yards  and  houses  are  not  kept  clean. 

III.  The  House  or  Septic  Fly,  which  mechanically 
carries  the  bacilli  of  typhoid  fever,  tuberculosis, 
cholera,  and  many  other  diseases  to  man  from 
infected  garbage  and  excreta.  It  breeds  in 
filth,  excreta,  and  garbage  of  all  kinds. 

IV.  Intestinal  Parasites. — In  a  separate  category 
stands  the  war  against  the  intestinal  worm 
known  as  the  Ankylostomum  or  Hook-worm, 
which  is  the  cause  of  tropical  ansemia  and  of 
much  tropical  sickness  in  general.  The  worms 
develop  in  the  excreta  of  persons  suffering 
from  the  disease,  or  in  contaminated  damp 
earth.  The  war  against  them  takes  the  form 
of  preventing  the  pollution  of  the  ground  by 
the  creation  of  proper  latrine  accommodation. 


CHAPTER  VII 

"stagnation,  the  great  enemy  of  life."    the  law 
against  stagnant  water  in  some  of  the  west 

INDIES 

Antilarval    bye -laws    and    regulations    have    been 
introduced  in — 

1.  Barbados. 

2.  Grenada. 

3.  St  Vincent. 

4.  St  Lucia. 

5.  Trinidad. 

6.  British  Guiana. 

7.  Nassau. 

8.  British  Honduras. 

They  all  aim  at  getting  rid  of  stagnant  water ;  the 
presence  of  mosquito  larvae,  or  mosquito  eggs  is  taken 
as  evidence  of  such  condition.  Householders  are 
usually  first  warned  by  the  sanitary  inspectors  of  the 
nuisance  and  danger  arising  from  stagnant  water,  and 
are  admonished  to  get  rid  of  it,  and  to  remove  all 
useless  water  receptacles.  Then  if  on  a  second  visit 
householders  have  not  complied  with  the  request  of  the 
sanitary  inspector,  or  have  not  taken  steps  effectively 


ANTILARVAL  LAWS,  BARBADOS  55 

to  screen  from  mosquitos  any  large  receptacle,  such 
as  a  tank,  which  they  may  possess,  they  are  summoned 
before  a  magistrate. 

1.  Antilarval  Measures  in  Barbados. 

In  the  Public  Health  Act  of  1898  there  were  up-to- 
date  regulations  for  the  destruction  of  larvae,  but  they 
were  not  enforced  until  1909,  when  they  were  re-issued 
in  handbill  form  as  follows  : — 

Extract  from  the  General  Board  of  Health  Rules,  22nd 
February  1909,  confirmed  by  the  Governor  in 
Executive  Committee  on  2&h  February,  and  pro- 
claimed in  the  Official  Gazette  on  \st  March  1909. 

2.  The  occupier  or  owner  of  any  premises  shall  keep 
such  premises  free  of  stagnant  water  liable  to  breed 
mosquitos,  and  the  presence  of  mosquito  larvse  in  any 
collection  of  water,  wherever  situated,  shall  be  sufficient 
evidence  that  such  water  is  stagnant.  All  tanks, 
fountains,  pools,  ponds,  or  excavations,  made  for  any 
purpose  whatever,  in  public  or  private  property,  which 
may  contain  water,  shall  be  kept  stocked  with  mosquito- 
destroying  fish,  or  shall  be  kept  covered  with  a  film  of 
petroleum  oil. 

3.  The  occupier  or  owner  of  any  premises  shall  keep 
his  premises  free  of  articles  (bottles,  whole  or  broken, 
old  tins,  boxes,  conch  shells,  etc.)  which  may  retain 
water  and  so  become  the  breeding  place  of  mosquitos. 

4.  All  cess-pits  which  retain  water  shall  be  dis- 
infected or  oiled,  except  they  be  efficiently  covered  and 
trapped. 

5.  All  gutters  and  down-pipes  shall  be  maintained 
in  good  repair  and  free  of  obstruction,  so  as  to  prevent 
the  accumulation  of  water  therein,  and  so  as  to  allow 
the  ready  passage  of  water  from  the  roofs  of  houses. 


56 


THE  GREAT  ENEMY 


6.  All  Inspectors  of  Health  shall  have  authority  to 
enter  any  premises  at  any  time  between  the  hours  of 
7  A.M.  to  6  P.M.  for  the  purpose  of  seeing  that  these 
regulations  are  carried  out,  and  may  pour  oil,  or  cause 
oil  to  be  poured,  on  the  surface  of  water  contained  in 
any  receptacle  in  or  on  such  premises. 

Penalty  for  infringement  of  Bye-laws  of  the  Com- 
missioners of  Health,  a  sum  not  exceeding  £5. 

Penalty  for  infringement  of  Eules  of  the  General 
Board  of  Health,  a  sum  not  exceeding  £10,  to  be 
recovered  before  a  police  magistrate. 

By  order. 

S.  E.  Brewster, 

Inspector  of  Health,  No.  2  District, 


During  my  visit  to  Barbados,  and  afterwards,  a 
vigorous  system  of  house-to-house  inspection  took 
place ;  after  warning,  if  no  amelioration  took  place,  the 
offenders  were  brought  before  the  magistrates. 

From  the  notes  furnished  me  by  Mr  Brewster, 
Chief  Inspector  of  No.  2  District,  the  number  of 
receptacles  of  water  emptied  containing  mosquito 
larvae  were : — 


Week  ending  March  13,  1909 

209 

if                i>       ^^}     }} 

150 

»                ))       27, 

283 

„             April      2, 

228 

»                »         "j 

267 

17 

41 

„              May       8,     . 

19 

w                   »         15^ 

29 

These  figures  show  that  householders  were  beginning 
to  pay  more  attention,  for  there  is  a  decline  in  the 
number  of  receptacles  emptied,  which  contained  larvae. 


PROSECUllONS 


57 


Mr  Brewster  prosecuted  in  71  cases,  obtaining  a 
conviction  in  each  instance,  small  fines  being  imposed. 
In  a  few  cases  the  defendants  were  admonished  without 
a  fine. 

Chief  Inspector  Williams,  of  No.  1  District,  in 
Bridgetown,  has  also  kindly  furnished  me  with  the 
following  notes : — 


Cisterns. 

Barrels. 

Tubs. 

Saucers 

for 
Plants. 

Vases. 

Cesspools. 

Total 
Receptacles. 

o 

C5 

US 

i-i 

1 

cS 

o 

1 
1 

i" 

14 
13 
26 
43 
16 
27 
36 
44 
30 
28 
43 
28 
55 
13 
81 
87 
71 
64 

14 
2 
4 

3 

"4 

19 

"i 

7 

... 
3 

... 

"2 

1 

i 

30 
15 
30 
48 
19 
27 
41 
48 
30 
47 
44 
29 
56 
15 
81 
87 
71 
71 

Totals 

4 

719 

54 

5 

2 

784 

26  persons  were  convicted  for  having  larvae  in  their  receptacles. 
2         „  „  „  larvae  in  their  gutter. 

Fines  varied  from  one  to  forty  shillings. 


2.  Antilarval  Measures  in  Grenada. 

In  Grenada,  under  the  Public  Health  Ordinance  of 
1902  and  1905,  regulations  were  made,  April  1907, 
dealing  with  larvae  destruction  as  follows : — 

5.  Immediately  upon  any  case  of  yellow  fever  being 
reported  in  any  place  in  a  district,  the   local   sanitary 


58  THE  GREAT  ENEMY 

Authority  shall  cause  regular  house-to-house  visitations 
to  be  made  in  the  vicinity  of  such  place,  to  ascertain 
whether  any  other  cases  of  fever  have  occurred;  and 
the  district  Medical  Officer  shall  assist  the  Local 
Sanitary  Authority  and  its  inspectors  in  such  visitation, 
and  they  are  hereby  empowered  to  strictly  enforce  the 
following  measures  for  the  eradication  of  mosquitos  in 
such  place  and  its  neighbourhood  : — 

(a)  No   water   shall    be    stored    (except    in   small 

quantities  for  drinking  purposes),  unless  effi- 
ciently protected  against  mosquitos  by  the 
following  method: — 

All  tanks,  barrels,  etc.,  for  storing  water, 
shall  have  all  openings  except  the  draw- off 
opening  covered  with  wire  gauze  (18  meshes  to 
the  inch),  or  with  a  piece  of  cheese  cloth,  and 
all  fountains,  pools,  ponds,  or  excavations, 
made  for  any  purpose  whatever,  in  public  or 
private  property,  which  may  contain  water, 
shall  be  kept  stocked  with  mosquito-destroying 
fish,  or  shall  be  kept  covered  with  a  film  of 
petroleum. 

(b)  The  occupier  or  owner   of  any  premises   shall 

keep  such  premises  free  of  stagnant  water 
liable  to  breed  mosquitos,  and  the  presence  of 
mosquito  larvae  in  any  collection  of  water, 
wherever  situated,  shall  be  sufficient  evidence 
that  such  water  is  stagnant. 

(c)  The  occupier  or   owner   of  any   premises   shall 

keep  his  premises  free  of  all  articles  (bottles, 
whole  or  broken,  old  tins,  boxes,  conch  shells, 
etc.)  which  may  contain  water  and  so  become 
the  breeding  places  of  mosquitos,  including 
broken  bottles  on  walls. 

(d)  All  watery  cess-pits  shall  be  disinfected  or  oiled, 

and  all  catch-pits  cleaned  out  at  least  once  a 
week. 


ANTILARVAL  LAWS,  GRENADA  59 

(e)  All  eaves-gutters  and  down-pipes  shall  be 
maintained  in  good  repair  and  free  of  obstruc- 
tion, so  as  to  allow  the  ready  passage  of  water 
from  the  roofs  of  houses. 

(/)  The  District  Medical  Officer,  or  any  person 
authorised  by  him  in  writing,  shall  have 
authority  to  enter  any  premises  at  any  time 
between  the  hours  of  6  a.m.  and  8  p.m.  for  the 
purpose  of  seeing  that  these  regulations  are 
carried  out. 

Since  my  visit  (May  1909),  the  Board  of  Health 
issued  the  following  further  regulations  : — 

Public  Health  Ordinances,  1902  and  1905. 

Regulations  for  Declaring  the  Breeding  Places  of 
Mosquitos  in  and  about  Human  Habitations  to  be 
Statutory  Nuisances. 

Under  and  by  virtue  of  sections  11  and  23  of  the 
Public  Health  Ordinance,  1902,  the  General  Board  of 
Health  hereby  declares  the  following  matters  to  be 
deemed  nuisances  liable  at  all  times  to  be  dealt  with 
summarily  under  the  provisions  of  the  said  Ordinance  : — 

1.  Any  accumulation  of  any  stagnant  water  in  any 
town  or  in  or  about  any  human  habitation,  which 
accumulation  results  from  want  of  proper  care  or  from 
want  of  repair  to  any  construction  or  defective  con- 
struction. 

2.  Any  articles  or  receptacles  or  any  construction 
holding  stagnant  water,  not  being  a  receptacle  or  con- 
struction designed  and  used  for  the  storage  of  water. 

3.  Any  receptacle  or  construction,  designed  and 
used  for  the  storage  of  water,  which  is  not  either — 

(i)  cleared  or  emptied  daily,  or 


60  THE  GREAT  ENEMY 

(ii)  effectively  screened,  from  the  access  thereto  by 
mosquitos  with  wire-gauze  (18  mesh,  at  least, 
to  the  inch),  or,  in  the  case  of  receptacles  kept 
in  the  house,  with  a  covering  of  cheese-cloth, 
or 

(iii)  stocked  with  mosquito-destroying  fish,  or 

(iv)  covered  with  a  film  of  oil. 

4.  Any  pond  or  pit  containing  water,  situated  in  a 
town  or  within  150  yards  of  a  human  halDitation,  which 
is  not  stocked  with  mosquito-destroying  fish  or  covered 
with  a  film  of  oil. 

5.  Any  receptacle  used  for  storing  water,  which 
receptacle  may  have  been  condemned  as  unnecessary 
under  notice  in  writing  of  the  local  sanitary  authority 
served  or  left  on  any  premises  in  pursuance  of  the 
provisions  of  any  regulations  made  under  the  authority 
of  section  20  of  Ordinance  No.  13  of  1905. 

And  it  is  hereby  declared  that  any  collection  of 
water  shall  for  the  pm^poses  of  these  regulations  be 
regarded  as  "  stagnant  water "  if  the  same  contains 
mosquito  larvae,  or  if  the  same  has  been  left  undisturbed 
for  a  period  exceeding  18  hours. 

Made  by  the  General  Board  of  Health,  this  21st 
day  of  June  1909. 

By  order  of  the  Board. 

T.  T.  Dyer, 

Clerh  to  General  Board  of  Health. 

3.  Antilarval  Measures  in  St  Vincent. 

In  St  Vincent  regulations  were  made,  under 
Ordinance  3,  1901,  dealing  with  larvae  destruction  as 
follows  : — 

3.  The  occupier  of  any  premises  in  any  town,  or  in 


ANTILARVAL  LAWS,  ST  VINCENT  61 

case  of  there  being  no  person  in  occupation,  the  owner 
thereof,  shall  keep  the  premises  free  from  stagnant 
water  likely  to  breed  mosquitos,  and  the  presence  of 
mosquito  larvae  in  any  collection  of  water  shall  be 
sujBficient  evidence  that  such  water  is  stagnant ;  and  he 
shall  also  keep  the  premises  free  from  tins,  bottles, 
whole  or  broken  (including  broken  bottles  on  walls), 
tubs,  barrels,  odd  receptacles,  broken  crockery,  etc., 
kept  or  left  in  a  position  likely  to  accumulate  and 
retain  water  and  so  become  breeding  places  for 
mosquitos. 

4.  Immediately  upon  any  case  of  yellow  fever  or 
suspected  yellow  fever  being  reported,  the  Local 
Authority  or  Local  Authorities  for  the  district  or 
districts  in  or  near  to  which  the  case  has  occurred  shall 
make  or  cause  to  be  made  regular  house-to-house 
visitation  in  their  district  in  the  vicinity  of  such  place 
to  ascertain  whether  any  other  cases  of  fever  have 
occurred,  and  the  Government  Medical  Ofi&cer  of  the 
district  shall  assist  the  Local  Authority  by  examining 
any  person  the  Local  Authority  may  require,  and  the 
Local  Authority  shall  see  that,  in  any  town,  the  pro- 
visions of  the  last  preceding  regulation  have  been,  and 
are,  observed,  and  shall  also  have  power  and  authority 
to  order  and  direct  the  owner  or  occupier  of  any 
premises  in  the  neighbourhood  of  which  any  such  case 
has  occurred,  and  whether  the  premises  be  or  be  not 
in  any  town  for  a  period  of  not  exceeding  three  months 
from  such  order  and  direction  : — 

(a)  To   comply   with   the   requirements  of  the  last 

preceding  regulation. 

(b)  To  cover  all  openings  except  the  draw- off  open- 

ing in  tanks,  barrels,  etc.,  used  for  storing 
water,  with  wire-gauze  (not  less  than  18  mesh 
to  the  inch),  or  with  a  piece  of  cheese-cloth. 

(c)  To  either  cover  and  keep  covered  with  a  film  of 

kerosene  oil,  or  draw  off  and  keep  drawn  off,  or 


62  THE  GREAT  ENEMY 

fill  up,  all  pools,  ponds,  or  excavations  made 
for  any  purpose  which  may  contain  water. 

(d)  To  disinfect  in  manner  directed,  or  to  oil  once 

a  week,  any  watery  cess-pit,  and  to  flush  out 
or  clean  at  least  once  a  week  any  drain  or 
gutter. 

(e)  To  repair  and  free  from  obstruction  any  eaves, 

gutters,  and  down-pipes,  and  to  keep  the  same 
repaired  and  freed  from  obstruction,  so  as  to 
allow  the  free  passage  of  water  from  the  roofs 
of  houses. 

All  persons  shall  comply  with  the  orders  or  direc- 
tions of  the  Local  Authority,  or  of  any  inspector 
authorised  by  them  in  writing,  in  respect  of  any  of  the 
above  matters. 

5.  The  Local  Authority,  or  any  person  authorised 
in  writing  by  the  Local  Authority,  is  hereby  empowered 
to  enter  any  premises  at  any  time  between  the  hours  of 
6  A.M.  and  6  p.m.  for  the  purpose  of  enforcing  the  pro- 
visions of  these  regulations. 

Made  by  the  Governor  in  Council, 
this  8th  day  of  May  1907. 

V.  F.  Drayton, 

Acting  Clerk  of  Goxincil. 

N.B. — By  the  provisions  of  section  21  of  the  Public 
Health  Ordinance,  1901,  any  person  who 

1.  Violates  these  regulations  ;  or 

2.  Refuses  or  neglects  to  obey  the  same ;  or 

3.  Resists,  opposes,  or  obstructs  the  lawful  execu- 

tion thereof — 

is  liable  to  a  penalty  not  exceeding  twenty  pounds,  or 
to  imprisonment  with  or  without  hard  labour  for  any 
period  not  exceeding  six  months. 


ANTILARVAL  LAWS,  ST  LUCIA  63 

This  year  (1909)  a  new  Bill  is  being  prepared,  to  be 
called  the  Public  Health  Ordinance,  1909,  containing 
provisions  against  stagnant  water  and  mosquito  larvae. 
Provision  is  made  for  bringing  water  under  proper 
control  and  supervision,  etc. 

4.  Antilarval  Measures  in  St  Lucia. 

The  following  useful  notice  has  recently  been  issued 
to  householders  in  St  Lucia  : — 

1.  In  the  general  interest  of  the  public  health,  and 
particularly  to  prevent  the  introduction  and  spread  of 
yellow  fever,  which  would  most  seriously  affect  the  trade 
of  the  island,  every  householder  is  invited  to  co-operate 
with  the  Health  Authorities  in  the  destruction  of 
mosquitos. 

2.  It  is  by  mosquitos  that  yellow  fever  and  the 
ordinary  malarial  fever  are  carried  and  spread. 

3.  Mosquitos  can  only  breed  in  stagnant  water, 
therefore  you  are  requested  to  see  that — 

(a)  Any  tanks  or  jars  or  other  water  receptacles  in 

your  yard  are  screened  according  to  the  Board 
of  Health  Regulations,  to  prevent  mosquitos 
getting  into  the  water  to  breed. 

N.B. — The  Health  Authorities  will  be  prepared  to 
examine  premises  and  give  advice  as  to  the  proper  way  of 
screening,  etc.  In  Castries  a  specimen  of  such  screening  can 
be  seen  at  the  Police  Station. 

(b)  All  wells  are  filled  up. 

N.B. — Well-water  in  Castries  is  most  unwholesome. 

(c)  None   of  the  following   articles  are  kept  lying 

about  your  yard  or  lots  : — 

(1)  Bottles,  whole  or  broken. 


64  THE  GREAT  ENEMY 

(2)  Tins; 

(3)  Broken  pieces  of  earthenware ; 

(4)  Coco-nuts; 

(5)  Calabashes; 

or  any  other  thing  capable  of  holding  water. 

(d)  That  all  hollows  in  the  ground  about  your  yards 

or  adjacent  premises  are  filled  up  to  the  level, 
so  that  water  may  not  collect  in  them. 

(e)  That  water  kept  in 

(1)  Washing-tubs, 

(2)  Flower  vases, 

(3)  Chickens'  drinking-vessels, 

is  changed  very  frequently  and  the  vessels  kept 
free  from  moss,  because  the  green  moss  found  in 
such  vessels  harbours  the  mosquito  larvae  and 
keeps  them  alive  while  the  water  is  being 
changed. 

Issued  by  advice  of  the  Medical  Board. 
H.  A.  Smallwood, 

Jidy  7,  1909.  Acting  Colonial  Secretary. 

Examination  of  the  Inspector's  note-book  gives  the 
details  of  inspections  and  how  the  yards  of  the  inhabi- 
tants of  Castries  are  carefully  examined  for  the  presence 
of  water  receptacles,  rubbish,  and  especially  larvae. 

At  first,  the  book  shows  that  the  inhabitants  were 
cautioned  against  the  dangers  of  stagnant  water  and 
harbouring  larvae.  Finally,  summonses  were  obtained. 
After  regulations  were  passed  making  it  an  ofi'ence  to 
harbour  larvae,  the  following  prosecutions  took  place  : — 


Year  1907   . 

13 

„  1908 

57 

„   1909  (January  to  April). 

28 

PROSECUTIONS 


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66  THE  GREAT  ENEMY 

5.  Antilarval  Regulations  in  Trinidad. 

In  March  1907  regulations  were  made  under  section 
8  of  Ordinance  188,  to  deal  with  yellow  fever  by  screening 
patients,  fumigation,  etc.,  and  by  prohibiting  the  keeping 
of  stagnant  water,  unless  properly  protected.  It  runs 
as  follows : — 

(a)  No    water    shall    be  stored   (except    in    small 

quantities  for  drinking  pm^poses)  unless  efficiently 
protected  against  mosquitos  by  the  following 
method : — 

All  tanks,  barrels,  etc.,  for  storing  water 
shall  have  all  openings  except  the  draw-off 
opening  covered  with  wire-gauze  (18  mesh  to 
the  inch),  or  with  a  piece  of  cheese-cloth  or  fine 
mosquito  netting,  and  all  fountains,  pools,  ponds, 
antiformicas,  or  excavations  made  for  any  pur- 
pose whatever,  in  public  or  private  property, 
which  may  contain  water,  shall  be  kept  stocked 
with  mosquito-destroying  fish,  or  shall  be  kept 
covered  with  a  film  of  petroleum  oil. 

(b)  The  occupier   or  owner  of  any  premises   shall 

keep  such  premises  free  of  stagnant  water 
liable  to  breed  mosquitos,  and  the  presence  of 
mosquito  larvge  in  any  collection  of  water, 
wherever  situated,  shall  be  sufficient  evidence 
that  such  water  is  stagnant. 

(c)  The  occupier  or  owner  of  any  premises  shall  keep 

his  premises  free  of  all  articles  (bottles,  whole 
or  broken,  old  tins,  boxes,  conch  shells,  etc.) 
which  may  retain  water  and  so  become  the 
breeding  places  of  mosquitos. 

{d)  All  watery  cess -pits  shall  be  disinfected  or  oiled 
and  all  catch-pits  cleaned  out  at  least  once  a  week. 

(e)  All    eaves-gutters    and    down-pipes     shall     be 


PROSECUTIONS  67 

maintained  in  good  repair  and  free  of  obstruction, 
so  as  to  allow  the  ready  passage  of  water  from 
the  roofs  of  houses. 

{/)  The  Medical  Officer  of  Health,  or  any  person 
authorised  by  him  in  writing,  shall  have  authority 
to  enter  any  premises  at  any  time  between  the 
the  hours  of  6  a.m.  and  8  p.m.  for  the  purpose 
of  seeing  that  these  regulations  are  carried  out. 

6.  Any  person  failing  to  comply  with  these  regula- 
tions shall  be  guilty  of  an  offence  and  be  liable  to  a  fine 
not  exceeding  twenty  pounds. 

In  the  new  draft  Ordinance  for  1909,  provisions 
similar  to  the  above  are  inserted  for  dealing  with  the 
breeding  places  of  mosquitos. 

Prosecutions  —  {Port  of  Spain  Gazette,  6th  May 
1909). — For  failing  to  keep  their  premises  free  from 
stagnant  water  liable  to  breed  mosquitos,  four  persons 
were  prosecuted  at  the  City  Police  Court  yesterday.  In 
each  case  a  conviction  was  secured,  and  the  fine  imposed 
5s.  or  seven  days'  imprisonment. 

Return  of  Prosecutions  under  Antimosquito  Regulations, 
from  1st  April  to  8th  December  1909. 

Total  number  of  informations  laid    .  .  .         .  .         .       152 

Number  fined  (all  convictions,  with  one  exception)  .  .  .       151 

Number  reprimanded  and  discharged        .....  1 

(The  summons  was  served  by  mistake  on  the  owner  instead  of  on 
the  occupier.) 

Kind  of  receptacle  in  which  larvae  were  found  : — 

Antiformicas  ......  70 

Barrels  .......  64 

Tubs 13 

Disused  tins  ......  2 

Eaves-gutters          .....  2 

Bottles  .         .         .         .         .         .         .1 

T52 
Amount  paid  in  fines        .......  £25     8     6 

The  fines  varied  from  Is.  to  10s. 


68 


THE  GREAT  ENEMY 


Return  of  Cases  prosecuted  hy  the  Acting  Sanitary 
Inspector  for  Breach  of  Regulations,  under  Order 
188  of  January  16,  1908. 


Date  of  Offence. 

Offence. 

Date  heard. 

Judgment. 

1.  March  5,  1909 

Stagnant  water  in 
barrels 

March  16,  1909 

2.       „       17,1909 

Stagnant  water  in 

„      26,  1909 

lOs.  fine  or  7  days' 

barrels  and  tubs, 

imprisonment. 

with  mosquito 

larvae 

3.  April  17,  1909 

April    23,  1909 

£3  or  14  days. 

4. 

5.  , 

6.  , 

,     20,  1909 

„      29, 1909 

2s.  6d.  or  7  days. 

,'     19,"l909 

55 

7.  , 

8.  , 

9.       , 
10.       , 

'' 

11.       , 

,, 

12.       , 

13.       , 

5» 

14.       , 

„ 

15.       , 

,, 

16.       , 

S» 

17.       , 

18.       , 

\     21,"l909 

,, 

19.       , 

20.       , 

»s 

21.       , 

,, 

22.       , 

,, 

"            9 

23.       , 

,'    20,"l909 

,, 

24.       , 

,     22,  1909 

May  3,  1909 

5s.  or  7  days. 

25.       , 

,     23,  1909 

„     5,  1909 

»»        »» 

26.       , 

,,         »» 

27.       , 

»>         ?> 

,,        ,, 

28.       , 

5»                   »» 

,,        ,, 

29.       , 

,'    28,"l909 

„     7,  1909 

£1  or  14  days. 

Summary  of  Prosecutions  frovi  btk  March  to  28th  April  1909. 

29  prosecutions  for  keeping  stagnant  water  in  barrels  or  with 
mosquito  larvae. 

heard  on  March  16,  1909 

„  „        26,  1909 

April 


1 
1 
1 

20 
1 

_5 

29 


May 


23,  1909 
29,  1909 
3,  1909 
5,  1909 


Convictions  were  obtained  in  all  cases. 


ANTILARVAL  LAWS,  BRITISH  GUIANA  69 

In  1  case  a  fine  of  10s.  was  imposed 

1  }}         }>      ^1  » 

5  cases  fines  of  5s,  were  imposed 
20        „         „      2s.  6d. 

The  fines  were  paid  in  all  cases  except  that  in  which  a  fine  of  £3 
was  imposed.     The  defendant  elected  to  go  to  prison  for  14  days. 

Total  fines  paid,  £5,  5s. 


6.  Antilarval  Measures  in  British  Guiana. 

The  old  Public  Health  Act  not  containing  any 
reference  to  antimosquito  measures,  special  bye-laws 
were  enacted. 

In  1905  a  bye-law  for  the  cleansing  of  tanks,  without, 
however,  special  reference  to  larvae,  was  issued. 

In  1907,  bye-laws  relating  to  the  screening  of  vats, 
etc.,  as  a  preventative  against  mosquitos  were  pro- 
mulgated, under  the  title  "Mosquito  Prevention  Bye- 
laws,  1907,"  as  follows  : — 

Bye-laws  Relating  to  the  Screening  of  Vats^  etc.,  as  a 
Preventative  against  Mosquitos. 

1.  These  bye-laws  may  be  cited  as  the  Mosquito 
Prevention  Bye-laws,  1907. 

2.  All  vats,  tanks,  or  other  vessels  shall  be  screened 
with  mosquito-proof  wire-netting,  or  other  suitable 
material,  so  as  to  prevent  the  entrance  into  or  exit  of 
mosquitos  from  such  vats  or  tanks  or  other  vessels. 

3.  The  inlet  and  overflow  pipes  into  such  vats,  tanks, 
or  other  vessels  shall  be  placed  in  such  positions  or 
screened  in  such  a  manner  as  to  prevent  the  entrance 
into  or  exit  from  the  same  of  mosquitos. 

4.  All  buckets  or  other  vessels  containing  water  for 


70  THE  GREAT  ENEMY 

fire -extinguishing  or  other  purposes  shall  be  emptied 
and  cleansed  at  least  once  a  week. 

5,  The  work  of  screening  the  vats,  tanks,  and  all 
such  other  vessels  shall  be  done  by  the  owners  of  the 
properties  on  which  they  are  situated,  and  all  vats, 
tanks,  or  other  vessels  shall  be  screened  within  three 
months  from  the  date  of  the  coming  into  force  of  these 
bye-laws. 

6.  Any  person  contravening  any  of  these  bye-laws 
shall  be  guilty  of  an  offence,  and,  on  summary  con- 
viction, be  liable  to  a  penalty  not  exceeding  ten 
dollars. 

Made  by  the  Mayor  and  Town  Council  of  George- 
town, under  section  179  of  the  Local  Govern- 
ment Ordinance,  1907,  and  confirmed  by  the 
Governor  and  Court  of  Policy,  on  the  second 
day  of  September  1907. 

These  do  not  appear,  owing  to  considerable  prejudice, 
to  have  been  enforced.  I  had,  however,  the  opportunity 
of  discussing  them  with  the  Mayor  and  Town  Council, 
with  the  result  as  follows  : — 

Public   Notice. 

Vat- Screening. 

The  Mayor  and  Town  Council  having  directed  that 
the  Vat- Screening  Regulations  of  1907  are  in  future  to 
be  rigidly  enforced,  and  the  Sanitary  Inspectors  of  the 
several  wards  having  been  instructed  to  notify  property 
owners  and  householders  accordingly,  public  notice  is 
hereby  given  that  all  persons  failing  by  the  15th  July 
next  to  comply  with  such  regulations  in  respect  to  the 
efficient  screening  of  tanks,  vats,  barrels,  and  other 
vessels  used  for  the  storage  of  water,  will  be  proceeded 
against  as  the  law  du-ects. 


SCREENING  ORDINANCE  71 

Advice  as  to  the  best  methods  of  screening  to  be 
adopted  will  be  given  v^hen  required  on  application  at 
my  office. 

By  order  of  the  Mayor  and  Town  Council. 

Luke  M.  Hill, 

Town  Superintendent. 
Town  Hall,  Georgetown, 
June  8,  1909. 

Note.  —  Correspondence  in  connection  with  the 
screening  of  vats  in  Georgetown  : — 

Sir, — In  reference  to  your  paragraph  in  this  morn- 
ing's issue  about  vat-screening  in  Georgetown,  I  may 
mention,  for  the  information  of  the  public,  that  many 
hundred  vats  have  already  been  screened,  notwithstand- 
ing your  statement  that  only  "a  comparatively  small 
number  "  have  been  so  treated. 

It  may  be  of  some  interest  to  those  property  owners 
still  in  default  to  know  that  the  following  general  order 
to  town  overseers  was  issued  by  me  on  Thursday : — 

"  As  the  days  of  grace  allowed  for  vat-screening 
expire  to-day,  I  shall  be  glad  if  the  overseers  will  make 
out  a  return  of  all  vats  screened  and  unscreened  in  their 
respective  districts,  with  a  view  of  instituting  some 
prosecutions  of  recalcitrant  owners  and  occupiers,  as  an 
example  to  others  ;  and  to  show  that  it  is  intended  to 
enforce  the  vat-screening  regulations. 

"  I  expect  these  returns  to  be  made  from  personal 
inspections  of  the  storage  vessels,  and  not  from  casual 
enquiries  made  from  the  householders.^ — I  am.  Sir,  etc., 

"Luke  M.  Hill, 

"  Town  Suj^erintendent. 
"Town  Hall, 

July  16,  1909.'' 


72  THE  GREAT  ENEMY 


Town  Superintendent's  Report. 

In  the  report  of  the  town  superintendent  for  July  it 
is  stated,  inter  alia,  that  vat- screening  operations  are 
still  being  busily  engaged  in  all  over  the  city,  so  that 
complete  returns  are  not  yet  available,  but  up  to  the  end 
of  July  it  is  computed  from  actual  figures  that  1300  vats 
are  already  screened,  being  about  35  per  cent,  of  the 
total  number  ;  but  barrels  and  other  small  water  recep- 
tacles, of  which  there  are  about  2500,  seem  hopeless. 


Drainage  Bye-laws  in  British  Guiana. 

By  Ordinance  13, 1907,  stress  has  been  laid  upon  the 
necessity  of  drainage.     The  bye-laws  are  as  follows  : — 

Drainage  Bye-laws 

For  the  city  of  Georgetown,  in  the  county  of  Demerara, 
colony  of  British  Guiana,  with  respect  to  the 
Drainage  of  Lots. 

Memorandum. 

The  Public  Health  Ordinance,  1878  (now  Local 
Government  Ordinance  No.  13,  1907),  enacts  : — 

23.  (174,  New  Ordinance  13,  1907).  The  owner,  or, 
when  required  by  the  local  authority,  the  occupier  of 
every  lot  of  land  situate  in  a  town  or  village  district 
shall  effectually  drain  the  lot,  and  for  that  purpose 
shall : — 

1.  Make  such  dams  and  drains  on  the  lot  as  may  be 

necessary  for  effectually  draining  the  lot ; 

2.  Fill  up  all  irregularities  in  the   surface  of  the 

lot ;  and 

3.  Adjust  the  surface  thereof,  and  if  necessary  raise 


ANTILAKVAL  LAWS,  NASSAU  73 

the   level   of   the    surface  thereof,   in   such   a 
manner — 

(a)  That  the  water  received  on  the  lot  may  flow 

into  the  drains  without  obstruction  ; 

(b)  That  no   water   can  remain   on   any   portion 

of  the  surface  of  the   lot  other  than  the 
drains ;  and 

(c)  That  the  surface  of  the  lot  does  not  remain 

swampy. 

Provided  that  where  the  swampy  state  of  any  lot  in 
any  such  district  is  occasioned  by  the  main  drains  into 
which  the  drains  of  the  lot  discharge  not  ha"\dng  a 
sufficient  outfall  or  a  sufficient  capacity  to  carry  off  all 
the  water  discharged  into  them,  the  owner  or  occupier 
of  the  lot  shall  not  be  liable,  under  this  section,  to  raise 
the  level  of  the  surface  of  the  lot,  if  theipevel  of  such 
surface  is  as  high  as  the  average  height  of  the  level  of 
the  land  surrounding  such  a  lot  for  a  distance  of  twenty 
roods ;  and 

Provided  that  any  owner  may,  with  the  consent  of 
the  local  authority  of  the  district  in  which  the  lot  is 
situated,  have  a  pond  on  the  lot. 


7.  Antilarval  Measures  in  Nassau.     The 
Bahamas. 

Measures  were  first  taken  in  1905  by  the  Board  of 
Health  against  mosquito -borne  diseases.  In  1906  the 
authorities  ckculated  my  pamphlet  upon  the  prevention 
of  yellow  fever,  and  imported  wu-e-gauze  for  distribution. 
In  1907  the  following  useful  antilarval  regulations  were 
drawn  up  and  circularised,  and  quinine  was  distributed 
at  cost  price  and  free  of  cost  to  the  poor. 


74  THE  GREAT  ENEMY 

Board  of  Health  Act,  1872. 

Rules  and  Regulatio7is,  October  1907. 

1.  The  owner  or  person  in  control  of  any  cistern, 
vat,  tank,  barrel,  bucket,  or  other  vessel  used  for  the 
storage  of  water,  shall  within  such  time  as  may  be 
specified  by  notice,  protect  the  same  from  mosquitos  in 
the  following  manner — that  is  to  say  :■ — 

I.  Cisterns,  tanks,  vats,  and  barrels  shall  be  provided 

with  covers  of  wood  or  metal,  and  all  openings 
other  than  the  delivery  exit  shall  be  screened 
with  netting. 

II.  Buckets  and  similar  or  other  retainers  shall  be 

protected  in  the  same  way  as  cisterns,  or  in 
some  other  manner  approved  by  the  Board. 

III.  Owners  and  occupiers  of  premises  on  which 
there  is  any  water  in  wells,  ponds,  pools,  or 
basins,  or  in  depressions  or  excavations  made 
for  any  purpose,  or  which  by  any  means  have 
occurred,  and  in  which  mosquitos  can  breed, 
shall,  within  such  time  as  may  be  specified  by 
notice,  protect  the  same  from  mosquitos  in  the 
following  manner — that  is  to  say  : — 

(1)  Stock  them  with  mosquito-destroying  fish ; 

(2)  Or  cover  them  with  protective  netting ; 

(3)  Or  drain  them  ofi*  at  least  once  a  week ; 

(4)  Or  cover  them  with  oil  at  least  once  every 

week  ;  or  fill  them  up  ; 

(5)  Or  (in  case   of  wells)   provide  them  with  a 

pump   and   mosquito-proof    cover    to    the 
satisfaction  of  the  Board. 

3.  All  empty  and  open  tins  shall  be  kept  in  such  a 


PENALTIES  75 

position  as  to  prevent  mosquitos  breeding  in  them,  and 
all  odd  receptacles,  such  as  jars,  broken  crockery, 
condensed  milk  tins,  and  other  rubbish  which  form 
receptacles  for  water  shall  be  removed  and  buried. 
All  doreys,  pit-pans,  and  boats,  in  use  or  discarded,  must 
be  kept  free  of  fresh  water. 

Penalties. 

4.  Any  person  committing  a  breach  of  any  of  these 
rules  and  regulations  shall  be  liable  on  summary 
conviction  to  a  penalty  of  £2,  and  on  a  second  con- 
viction to  a  penalty  not  exceeding  £5,  or  to  imprison- 
ment with  or  without  hard  labour  not  exceeding  thirty 
days. 

8,  For  Antimosquito  Measures  in  British 
Honduras,  see  Appendix. 


CHAPTER  VIII 

TRADE   ROUTES   AND   THE   EXTENSION   OF   DISEASE 

The  history  of  nations  teaches  us  that  extension  of 
trade,  and  increasing  intercourse  between  countries 
entail  also  the  diffusion  of  disease.  When  the  Conquista- 
dores  of  the  Old  World,  under  Columbus  and  Cortes,  set 
forth  to  conquer  and  exploit  the  New  World,  they  carried 
with  them  some  of  the  diseases  common  in  Europe. 

In  their  turn,  they  found  themselves  attacked  by,  to 
them,  new  and  mysterious  diseases,  such,  for  example, 
as  yellow  fever. 

From  the  evidence  which  I  have  examined,  I 
conclude  that  this  disease  was  in  all  probability 
endemic  and  universal  amongst  the  inhabitants  of  the 
new  world  at  that  period :  so  prevalent  and  endemic 
amongst  them,  and  probably  of  so  mild  a  nature,  that 
little  attention  was  paid  to  it  by  the  natives — much  in 
the  same  way  as  the  inhabitants  of  endemic  malarial 
countries  go  about  their  daily  avocation,  although  their 
blood  may  teem  with  the  malarial  parasites. 

Similarly,  we  may  with  reason  suppose  that  the 
native  inhabitants  of  the  newly  discovered  continent  acted 


YELLOW  FEVER  AND  SHIPS  77 

as  the  "healthy  carriers"  or  ambulatory  reservoirs  of 
the  yellow  fever  virus. 

From  this  source  the  Stegomyia  derived  a  constant 
and  abundant  supply  of  infection. 

The  new  arrivals  from  the  Old  World  were  at  once 
attacked  by  what  was  to  them  a  new  and  mysterious 
disease,  which  in  them  produced  the  most  severe 
symptoms.  So  severe  a  form,  in  fact,  did  the  new 
disease  assume  amongst  the  newcomers,  that  it  proved 
to  be  the  natural  barrier  against  the  progress  of  Euro- 
pean enterprise  in  the  New  World,  just  as  malaria 
and  sleeping  sickness  have  kept  back  white  enterprise 
in  Africa.  When  at  last  a  footing  was  obtained  in  the 
New  World — albeit  at  a  terrible  sacrifice  of  life  (as  we 
know  from  historic  records) — towns  sprung  into  exist- 
ence, and  a  constant  intercourse  was  kept  up  amongst  the 
various  ports  in  Central  and  South  America  and  the 
West  Indies,  as  well  as  with  the  Old  World,  and 
subsequently  with  North  America.  Now  it  is  precisely 
at  the  period  of  general  maritime  trade  expansion  that 
chroniclers  record  outbursts  of  yellow  fever  at  places 
where  the  disease  appears  not  to  have  been  previously 
noted.  Thus  the  ship  Oriflamme  is  blamed  for  having 
introduced  the  disease  into  Martinique,  the  ship  Hankey 
with  having  conveyed  it  to  Grenada,  and  the  ship  Grand 
Zurc  with  having  brought  it  back  to  Spain. 

Certain  it  is,  however,  that  the  period  of  commercial 
activity  coincides  with  the  diffusion  of  yellow  fever  over 
a  wide  area.  Southern  ports  and  towns  in  the  United 
States  became  infected,  due  to  trade  with  the  West 
Indies  and  the  Spanish   Main.     Spain,   as  one  would 


78  TRADE  ROUTES  AND  DISEASE 

expect,  owing  to  its  colonial  possessions,  was  the  first 
country  to  be  severely  afi'ected  in  Europe.  From  1700 
to  1800,  disastrous  epidemics  swept  through  the  southern 
portion  of  the  Peninsula.  Later,  Portugal,  Gibraltar, 
France,  and  even  England  were  visited.  But  in  Europe 
the  conditions  did  not  exist  for  the  long  persistence  of 
the  infection,  and  with  the  exception  of  a  few  imported 
cases,  the  disease  soon  died  out.  In  the  West  Indies, 
and  in  certain  Central  and  South  American  ports,  a 
precisely  similar  change  is  taking  place  :  the  disease  is 
becoming  rarer  as  the  Stegomyia  mosquito  is  disappear- 
ing, owing  to  the  new  conditions  of  the  water-supply 
doing  away  with  the  breeding  places  of  the  mosquito,  and 
we  can,  with  confidence,  look  forward  to  the  time  when 
yellow  fever  will  be  as  unheard  of  in  many  of  these 
places  as  it  is  in  Europe  at  the  present  time. 

A  few  endemic  foci  are,  however,  sure  to  hold  out 
until  they  have  been  dealt  with  by  the  modern  sanitary 
forces.  Such  foci  are  to  be  encountered  along  the 
Amazon,  the  Orinoco,  and  in  certain  other  Central 
American  states  ;  but  they,  too,  no  doubt  will  disappear 
in  process  of  time.  To  retm^n  to  the  effect  of  trade 
intercom'se  upon  the  diffusion  of  disease,  we  find  yellow 
fever,  for  example,  called  "  ships' "  or  "  sailors' "  fever, 
the  name  "yellow  jack"  surviving  to  this  day. 

Ships  have  always  been  regarded  as  the  worst 
offenders  in  the  propagation  of  the  disease.  The 
Stegomyia  not  having  been  known  in  those  days,  it  was 
thought  that  a  section  of  the  yellow  fever  climate  was 
conveyed  in  the  ship  from  the  infected  port  of 
departm'e,  and  dumped  down  at  the  port   of  arrival. 


STEGOMYIA  AND  SHIPS  79 

In  later  times  special  kinds  of  cargo  and  the  bilge  water 
were  in  their  turn  accused.  Thanks  now  to  modern 
discoveries,  we  know  that  the  explanation  why  ships 
did  and  may  still  carry  yellow  fever  infection  is  very 
simple.  The  yellow  fever  mosquito — the  Stegomyia 
calopus — can  live  as  easily  in  the  galley,  forecastle, 
staterooms,  and  holds  of  a  ship  as  in  a  house  on  shore. 
It  is  common  experience  now  that  when  ships  are 
moored  alongside  wharfs  or  pontoons,  or  stand  a  little 
way  off  from  shore,  when  moored  in  the  river  or  creek, 
that  they  are  invaded  by  mosquitos — many  of  which 
may  be  infected. 

Dr  Grubbs  of  the  U.S.  Marine  Medical  Service 
carefully  examined  82  vessels  coming  from  Stegomyia 
infected  ports.  In  three  cases  the  Stegomyia  was  found, 
although  the  duration  of  the  voyage  was  from  thirteen 
to  tvjenty  days.  Even  if  the  adult  Stegomyia  is  unable 
to  gain  access  to  the  ship,  the  eggs  and  larvae  may 
be  taken  in  with  the  drinking  water  stored  in  the 
casks  and  tanks  on  board  and  these  develop  during  the 
voyage. 

To  sum  up,  infected  or  non-infected  adult  Stegomyia 
may  come  on  board  at  the  port  of  departure.  If 
infected,  they  will  spread  infection  to  all  non-immune 
passengers  and  members  of  the  crew  whom  they  may 
chance  to  bite.  The  non-infected  Stegomyia  which  have 
come  on  board,  as  well  as  those  which  have  hatched 
out  from  the  larvae  in  the  water  on  board,  may  become 
infected  by  biting  a  passenger  or  one  of  the  crew,  who 
may  perchance  be  suffering  from  a  mild  attack  of  yellow 
fever ;  then,  w^ien  once  infected,  they  spread  the  disease 


80  TRADE  ROUTES  AND  DISEASE 

throughout  the  ship.  We  have  abundant  and  absolute 
proof  that  Stegomyia  are  carried  by  ships  for  very  long 
distances.  We  also  know  that  cases  of  yellow  fever 
develop  and  spread  long  after  a  ship  has  left  an  infected 
port,  and,  if  it  has  been  proved,  as  has  been  done,  that 
yellow  fever  is  only  transmitted  by  the  Stegomyia,  then 
what  has  been  shown  to  occur  on  land  can  also  occur 
on  shipboard,  provided  the  mosquitos  are  there.  In 
the  days  of  sailing  ships,  mosquitos  were  more 
frequently  encountered  on  board  than  they  are  in  the 
present-day  iron  steamers.  The  conditions  have  been 
completely  changed :  condensed  water  largely  replaces 
barrel  water;  there  is  far  better  ventilation  of  the 
living  quarters ;  and  greater  precautions  are  taken  to 
prevent  the  access  of  mosquitos  from  the  shore.  The 
result  is  that  "yellow  jack"  is  the  exception,  not  the 
rule,  on  ships  trading  in  the  yellow  fever  zone. 

It  has  also  been  proved  that  the  Stegomyia  may  be 
transported  in  baggage  and  in  cargoes. 

Again,  it  is  well  known  that  smallpox  and  plague 
are  both  frequently  spread  by  shipping.  It  is,  of  course, 
for  these  common-sense  reasons  that  the  laws  of 
quarantine  have  been  established  amongst  civilised 
nations.  We  know  that  plague  is  peculiarly  liable  to 
be  ship-transported,  because  of  the  frequency  of  rats  on 
ships,  and  it  is  for  these  reasons  that  such  stringent 
precautions  are  taken  to  prevent  the  access  or  egress  of 
rats  to  or  from  ships  when  in  port. 

It  is  easy  to  understand  that  when  large  bodies  of 
men  stream  from  one  point  to  another,  whether  on  foot, 
by  caravan,  rail  or  ship,  that  they  are  liable  to  carry 


RELATION  OF  DISEASE  TO  COMIVIERCE  81 

actual  infection,  or  the  insects  which  transmit  the 
infection.  It  is  the  same,  of  com'se,  in  the  case  of  the 
exportation  or  importation  of  animals  and  plants.  In 
one  of  his  works  on  Africa,  Livingstone  states  :  "  Before 
the  Arabs  came,  bugs  were  unknown ;  one  may  know 
where  these  people  have  been  by  the  absence  or 
presence  of  these  vermin." 

Writing  of  ticks,  which  transmit  relapsing  fever  in 
man,  Dutton  and  Todd  state  that  ticks  came  into  the 
Congo  Free  State  from  the  East  Coast  with  the  Arabs ; 
the  ticks  are  found  along  much-travelled  roads.  So 
with  the  tsetse  fly  and  sleeping  sickness,  the 
development  of  trade  routes  and  intertribal  movements 
are  responsible  for  the  spread  of  that  disease  in  the 
central  provinces  of  Africa.  The  pilgrimages  to  Mecca 
are  other  channels  through  which  infection,  plague,  or 
cholera  may  readily  flow. 

From  the  home  of  plague,  in  India,  that  disease  has 
steadily  spread  along  the  numerous  steamship  routes  to 
the  Far  East,  to  the  Pacific  side  of  the  American 
Continent,  and  through  it  to  the  Atlantic  side,  and  then 
to  the  West  Indies ;  to  the  East  Coast  of  Africa,  to  the 
Cape,  and  then  up  to  the  West  Coast ;  and  from  time 
to  time  a  few  cases  are  still  imported  into  Europe.  It 
is  surmised,  not  without  reason,  that  the  decadence  of 
ancient  Greece  was,  in  large  measure,  due  to  the 
importation  of  slaves  who  brought  with  them  the 
malaria  endemic  from  their  African  home. 

Similarly,  it  is  believed  that  malaria  was  introduced 
into  Ismailia  during  the  construction  of  the  Suez  Canal 
by  the  large  bodies  of  Italian  workmen,  who  were,  in  all 

F 


82  TRADE  ROUTES  AND  DISEASE 

probability,  largely  infected  with  malaria.  Both  in 
Greece  and  in  Ismailia  the  Anophelines  necessary  to  the 
extension  of  the  disease  were  present.  It  is  well  known 
that  malaria  was  prevalent  in  certain  marshy  districts  of 
England  in  the  seventeenth  and  eighteenth  centuries, 
and  it  is  possible  that  the  slave  trade  and  the  employ- 
ment of  black  servants,  which  was  in  vogue  at  these 
times,  was  not  altogether  unconnected  with  keeping 
up  the  supply  of  infection.  Medical  writers  of  the 
eighteenth  and  early  part  of  the  nineteenth  century  have 
many  times  described  the  horrors  incidental  to  the 
slave  trade,  and  have  drawn  attention  to  the  danger  of 
the  slave-ship  as  a  means  of  transmitting  disease.^  In 
the  days  of  the  commerce  in  human  beings,  writers  like 
Nicolas,  Guerin,  and  Corre  pointed  out  the  prevalence  of 
what  was  called  negro  lethargy  amongst  the  imported 
slaves  into  the  West  Indies.  We  now  know  that  this 
lethargy  was,  in  fact,  the  sleeping  sickness  of  to-day. 
The  slave  hunters  of  the  period  saw  its  disadvantage, 
and  tried  to  get  their  slaves  from  districts  reported  free 
of  the  disease.  The  interest  attaching  to  this  importa- 
tion of  sleeping  sickness  cases  into  the  West  Indies  lies 
in  the  fact  that  the  disease  did  not  take  root  and 
spread.  It  could  not,  for  the  simple  reason  that  the 
tsetse  fly  is  non-existent  in  the  Antilles.  For  like 
reasons,  malaria,  which  must  have  been  carried  into 
Barbados  on  countless  occasions  during  the  present  and 

1  Dr  Audouard  in  1824  tried  to  demonstrate  that  yellow  fever  was 
almost  peculiar  to  slave-ships.  That,  in  fact,  yellow  fever  was  the 
price  which  Em'ope  paid  for  the  slave  trade,  the  outbreaks  in  Spain 
being  attributed  to  the  arrival  of  an  old  slaver  engaged  in  the  human 
traffic. 


QUARANTINE  83 

past  centuries,  did  not  take  root  and  become  endemic. 
It  could  not,  because  of  the  natural  absence  of  Anophe- 
lines.  Considerations  like  these  should  bring  home  to 
everyone  the  practicability  of  preventing  such  diseases 
as  malaria,  yellow  fever,  and  plague  by  the  radical 
operation  of  destroying  the  insect-carriers.  Viewed  from 
this  standpoint,  tropical  sanitation  is  one  of  the  most 
hopeful  and  remunerative  undertakings  of  the  present 
century. 

These  considerations  also  show  us  the  importance  of 
exercising  vigilance  over  trade  routes  and  shipping. 
Observation  and  detention  camps  and  quarantine 
methods  cannot  yet  be  discarded,  although  the  discom- 
forts incidental  to  them  may  in  the  light  of  modern 
discoveries  be  greatly  mitigated. 


CHAPTER  IX 

HISTORY   OF   THE    1907-1909   OUTBREAK   OF   YELLOW 
FEVER   IN   BARBADOS 

I  ARRIVED  in  Barbados  on  1st  March  1909,  while  an 
outbreak  of  yellow  fever  was  passing  through  the  island. 

Origin  of  Outbreak. — Whence  did  it  come?  Was 
it  the  miasm  from  the  dead  of  past  decades  again 
awakening  to  life  ?  Or  was  it  some  foul  emanation 
from  a  forgotten  drain?  Or  had  someone  gone  to 
reside  in  a  house  where  in  the  past  yellow  fever  had 
occurred  ? 

One  physician  thought  that  any  of  these  alternatives 
might  have  been  the  cause,  and  was  prepared  to  bring 
much  ingenious  erudition  in  support  thereof.  At  any 
rate,  he  was  certain  it  could  not  be  the  mosquito,  for,  as 
he  argued,  the  mosquito  was  not  recognised  as  a  cause 
by  his  forefathers,  and  in  those  days  they  knew  all  about 
yellow  fever ;  therefore  it  was  the  miasm,  because  they 
said  it  was ;  but  this  physician  had  not  heard  of  Beau- 
perthuy  of  British  Guiana,  nor  had  he  troubled  to 
investigate  what  Manson,  Ross,  Carroll,  Agramonte, 
and  Lazear,  and  the  host  of  other  investigators  had 


w   is 


o  *< 


PREVIOUS  EPIDEMICS  85 

brought  to  light  in  the  meantime.  Miasm  was,  anyway, 
more  fanciful,  and  allowed  more  play  to  the  imagination 
and  to  conjecture,  than  a  commonplace  mosquito,  about 
which  everybody  in  Barbados  knew  everything  that 
could  possibly  be  worth  knowing. 

Previous  Yellow  Fever  Epidemics. — Students  wishing 
for  information  upon  the  past  history  of  yellow  fever  in 
Barbados  will  find  abundant  material  for  study,  buried 
away,  not  only  in  old  army  reports,  but  in  almost  any 
treatise  or  thesis  upon  yellow  fever,  so  prevalent  was  it 
at  one  time  in  Barbados. 

They  will  learn  that  yellow  fever  was  to  all  intents 
and  purposes  endemic,  with  unfailing  regularity  appear- 
ing every  year.  Thus  from  the  old  records  of  the 
military  medical  inspector  in  Barbados  we  learn  that 
the  disease  appeared  for  40  years  in  uninterrupted 
succession.  A  table  is  given  showing  the  months  from 
1815  to  1846  most  liable  to  yellow  fever,  and  so  on,  and 
so  on ;  for  details  see  Chapter  I. 

One  of  the  first  epidemics  of  yellow  fever  occurred 
in  Barbados  in  the  year  1647  :  at  least  so  it  is  recorded 
by  Ligon  in  his  history  of  Barbados ;  and  no  less  an 
authority  than  Humboldt  states  that  it  was  present  in 
1691,  and  was  known  as  Kendal's  Disease,  and  was 
imported  from  Pernambuco. 

Barbados  was  once  a  hot-bed  of  yellow  fever,  an 
endemic  centre  as  bad  or  even  worse  than  any  other 
part  of  the  yellow  fever  zone.  The  question  then 
arises  :  Was  the  present  (1907-1909)  outbreak  of  yellow 
fever  due  to  lingering  infection  in  the  island  ?  Or  was 
it  imported  from  without  ?     In  my  opinion,  the  evidence 


86  THE  1907-1909  OUTBREAK 

is  conclusive,  and  is  in  favour  of  the  latter  view.  The 
last  epidemic  was  in  1881,  and  since  that  date  new 
arrivals  have  not  contracted  yellow  fever  with  the 
regularity  and  certainty  that  they  would  have  done  had 
the  disease  been  chronic,  smouldering,  or  endemic  in  the 
island. 

We  are  obliged,  therefore,  to  conclude  that  the 
infection  which  was  responsible  for  the  present  out- 
break was  of  recent  introduction. 

The  infection,  once  introduced,  whether  in  the  person 
of  an  infected  man  or  infected  Stegomyia  coming  from 
the  Amazon,  the  Orinoco,  Martinique,  Trinidad,  or  else- 
where, found  the  conditions  in  Barbados  favourable  for 
its  propagation.  The  Stegomgia  calopus  was  the 
common  house-mosquito  of  Barbados,  and  was  every- 
where abundant  when  the  infection  was  introduced. 

I  am,  of  course,  well  aware  that  in  every  clime,  as 
Humboldt  observed,  "  men  fancy  to  derive  consolation 
in  the  idea  that  a  disease  which  is  considered  pestilen- 
tial has  been  brought  from  abroad.  This  belief  flatters 
the  national  pride.  To  inhabit  a  country  which 
produces  epidemics  might  be  deemed  a  humiliating 
circumstance,  and  it  is  more  satisfactory  to  consider 
that  the  malady  is  a  foreign  one,  and  that  its  breaking 
out  has  been  merely  the  effect  of  an  accident,  against 
which  it  will  be  easy  to  guard  in  another  instance. 
The  people  immediately  adopt  this  explanation  of  the 
disease  because  it  is  easily  comprehended.  The  medical 
men,  on  their  side,  in  general  rest  satisfied  with  it, 
because  the  word  importation  relieves  them  of  all 
responsibility  and  from  the  trouble  of  investigating  the 


FIRST  CASES  87 

nature  and  real  cause  of  the  disorder."  How  like  all 
this  is  to  the  reasoning  which  Barbados  adopted,  and, 
for  that  matter,  which  every  country  in  which  the 
pestilence  has  broken  out  in  the  modern  period  has 
likewise  employed. 

For  it  must  not  be  forgotten  that  in  the  days  of  old 
it  was  the  correct  thing  for  the  new  arrival  to  get 
yellow  fever  and  so  become  acclimatised,  before  he  or 
she  could  be  regarded  as  a  real  West  Indian  to  the 
manner  born. 

Nevertheless,  and  in  spite  of  the  past  history  of 
endemicity,  I  am  of  opinion  that  Barbados  was  infected 
from  without. 

The  following  are  the  chief  points  of  interest  in 
connection  with  the  origin,  course,  and  cessation  of  the 
epidemic. 

First  Notification. — In  November  1907  a  group  of 
seven  cases  were  notified  as  yellow  fever  in  Bridgetown. 
The  first  of  these  cases  was  notified  on  19th  November. 
The  patient  was  the  wife  of  the  resident  surgeon  of 
the  hospital,  and  she  had  been  on  the  island  eighteen 
months;  the  six  others  were  sailors  from  H.M.S. 
Indefatigable. 

H.M.S.  Indefatigable  arrived  at  Barbados  from 
Grenada  on  6th  November  1907.  On  18th  November 
three  seamen  were  admitted  to  the  general  hospital, 
and  were  found  to  be  suffering  from  yellow  fever,  and 
were  isolated.  Haddocks,  the  first  man  taken  ill, 
reported  sick  on  board  on  11th  November,  namely,  six 
days  after  the  arrival  of  the  ship.  These  three  seamen, 
and  three   others  also  affected   subsequently,  had   all 


88  THE  1907-1909  OUTBREAK 

spent  twenty-four  hours  on  shore  shortly  after  the 
arrival  of  the  ship,  and  it  was  found  on  enquiry  that 
they  had  spent  the  night  in  Kebbitt's  Land,  Bridgetown, 
which  is  behind  and  adjacent  to  the  general  hospital. 

At  2  A.M.  on  the  19th — about  twelve  hours  after  the 
admission  of  these  three  men  to  the  general  hospital — 
Mrs  Alleyne,  the  wife  of  the  senior  resident  surgeon, 
residing  in  the  quarters  of  that  officer  at  the  hospital, 
died  of  yellow  fever. 

This  clearly  pointed  to  an  infected  area  in  the 
immediate  vicinity  of  the  hospital,  and  this  area  was  at 
once  subjected  to  daily  inspection  and  special  anti- 
mosquito  measures — namely,  fumigation,  filling  up  or 
oiling  of  all  collections  of  stagnant  water — for  a  period 
of  six  weeks. 

No  case  of  yellow  fever  had  been  previously  notified, 
nor  was  any  suspicious  case  known  to  have  occurred 
for  a  considerable  time  before  this  date.  These  cases 
occurred  from  the  19th  to  the  21st  of  November.  The 
next  case  was  that  of  a  German  seaman,  notified  on 
30th  November,  also  staying  in  Bridgetown,  at  the 
Sailor's  Rest.  These  patients  were  obviously  infected 
in  Bridgetown ;  we  have  no  positive  evidence  that  they 
brought  infection  with  them.  The  doctor's  wife  had 
been  residing  eighteen  months  in  Bridgetown,  and  the 
H.M.S.  Indefatigable  had  not  come  from  a  yellow  fever 
port,  nor  had  there  been  yellow  fever  on  board. 

These  cases  constituted  the  first  signal  that  yellow 
fever  was  present,  and  they  show  unmistakably  that  there 
existed  in  Bridgetown  a  considerable  volume  of  infection 
— that  is,  that  a  very  large  number  oi  Stegomyia  must  have 


''k^ 
N^- 


PLAN  OF  BRlDG-ETowhl 


YiG,   6.— PLAN   OF   BRIDGETOWN,   SHOWING   DISTRIBUTION   OF    CASES 
OF   YELLOW  FEVER. 


[Face  page  S8. 


SPREAD  OF  EPIDEMIC  89 

been  infected — and  that  in  all  probability  Bridgetown 
must  have  been  infected  previous  to  November  :  in  other 
words,  the  outbreak  occurred  before  November,  but 
was, .as  is  so  often  the  case,  unrecognised.  The  early  cases 
were  probably  mild,  and  there  being  no  reason  to  suspect 
yellow  fever,  they  passed  unrecognised.  We  know 
from  experience  that  this  is  the  usual  course.  These 
cases  constituted,  as  Dr  Hutson  has  said,  the  "bolt 
from  the  blue "  :  the  new  arrivals  were  the  sensitive 
index  which  showed  at  once  that  yellow  fever  was  in 
the  island  ;  but  as  to  the  date  at  which  it  entered,  we 
have  at  this  lapse  of  time  no  reliable  means  of 
ascertaining. 

Spread  of  the  Epidemic. — The  first  cases  to  be 
notified,  as  we  have  seen,  were  in  Bridgetown,  in  the 
parish  of  St  Michael's.  On  11th  December  1907  > 
case  was  notified  in  the  parish  of  St  John,  and  one  in  the 
parish  of  St  Philip  on  16th  February  1907.  A  little 
later  the  infection  had  travelled  round  to  the  parishes  of 
St  Peter  and  St  Lucy,  the  first  case  notified  in  the  latter 
parish  being  on  29th  December  1908.  In  this  parish 
an  outbreak  occurred,  some  29  cases  being  recorded. 
On  26th  January  1909  the  parish  of  St  Joseph  became 
infected,  and  a  small  outbreak  also  occurred,  numbering 
some  18  cases.  In  the  meantime  (1909),  scattered 
cases  occurred  in  all  the  various  parishes.  The  chief 
foci  were,  however, Bridgetown,  in  St  Michael's;  St  Lucy ; 
and  St  Joseph.  The  last  case  notified  in  St  Michael's 
in  1907  was  dated  21st  November,  and  the  first  case  in 
1908  was  dated  8th  February,  and  was  clearly  due  to  the 
continuance  of  infected  Stegomyia.     From  the  middle  of 


90  THE  1907-1909  OUTBREAK 

March  to  llth  October,  when  another  case  was  notified, 
there  was  a  curious  cessation  of  notified  cases  of  yellow 
fever.  I  cannot  help  coming  to  the  conclusion  that  this 
apparent  cessation  was  due  to  wrong  diagnosis — in  other 
words,  there  were  probably  cases  of  yellow  fever,  but 
they  were  not  diagnosed  as  such.  The  result  is  that, 
starting  from  October  1908,  there  appears  to  have  been  a 
fresh  outburst,  not  only  in  St  Michael's,  but  throughout 
the  island,  due,  I  believe,  in  great  measure,  to  more 
accurate  diagnosis. 

Cessation  of  the  Epidemic. — Taking  Bridgetown,  in  the 
parish  of  St  Michael's,  we  have  seen  that  from  the  first, 
recourse  was  had  to  fumigation  and  isolation,  and  no 
doubt  the  experience  gained  in  1907  and  in  1908  led 
to  increased  efficiency  in  1909. 

With  increased  experience,  it  is  seen,  for  example, 
how  essential  it  is  to  notify  cases  at  once,  to  isolate 
them,  and,  above  all,  to  most  conscientiously  fumigate,  in 
order  to  destroy  infected  Stegomyia.  Experience  showed 
the  public  that  if  the  latter  measm^es  were  not  properly 
carried  out,  secondary  cases  were  bound  to  follow  in 
due  course.  That  this  was  so,  is  clearly  shown  by 
comparison  with  the  country  parishes  of  St  Lucy  and 
St  Joseph.  In  Bridgetown,  St  Michael's,  the  last  case 
is  dated  April  1909,  and  I  believe  there  have  been  no 
fresh  cases  since  then.  This  date  terminated  the 
Bridgetown  epidemic  just  when  the  "atmospheric  con- 
ditions," as  the  old  physicians  would  have  said,  were 
becoming  more  favourable  for  the  spread  of  the  fever. 

It  is  clear  that  the  early  notification,  more  accurate 
diagnosis,  and  the  isolation  of  the  patient,  coupled  with 


ISLAND 


PLAN     SHOWWW    THE    PAKIiHCS   ANO  THE    CASES 
OF  YELl-OW  FEVER.  REPfieSENTEBBtStACK  DOTS. 


FIG.   T. — PLAN   OF  BAEBADOS,   SHOWING   DISTRIBUTION   OF   YELLOW 
FEVER   CASES. 


[Face  page  90. 


SIZE  OF  EPIDEMIC  91 

fumigation  and  larval  destruction,  had  stopped  the 
.  further  progress  of  the  disease  in  Bridgetown.  But  in 
the  parishes  of  St  Lucy  and  St  Joseph,  where  the 
sanitary  staff  was  not  so  large  nor  so  experienced,  cases 
were  recorded  well  on  into  the  month  of  June,  and,  in 
the  case  of  St  Joseph,  into  August.  In  my  experience 
this  is  the  usual  occurrence  :  the  epidemic  is  stamped 
out  in  the  larger  and  better  staffed  towns  and  lingers  on 
in  the  outlying  villages. 

The  Board  of  Health  recognised  this,  and  therefore 
appointed  a  central  inspector  (Mr  Cumberbach)  on 
8th  February,  to  supervise  operations  over  the  island. 
This  inspector  drew  attention  to  the  often  faulty  method 
of  fumigation,  and  pointed  out  that  all  chinks  and  holes 
in  the  cottages  were  not  always  stopped  up  before 
fumigation.  Of  course  it  is  difficult  to  seal  the  rickety 
wooden  huts  and  houses  of  the  poorer  classes,  but,  as 
demonstrated  repeatedly  in  Cuba  and  many  other  places, 
it  is  quite  feasible  with  skill  and  patience  to  paper  rickety 
shingle-covered  houses  so  that  it  is  impossible  for 
infected  mosquitos  to  escape. 

Size  of  the  Epidemic. — Reckoning  from  1907,  the 
total  number  of  cases  recorded  was  approximately  100  or 
a  little  over,  or  reckoning  from  the  end  of  1908  into  1909, 
some  86  cases. 

It  was  a  matter  for  comment  that  so  many  of  the 
native  black  residents  were  affected,  viz.,  54  out  of  the 
total  of  86.  This  simply  indicates,  as  I  point  out  further 
on,  that  the  native  residents  were  non-immunes,  as  an 
interval  of  some  26  years  had  occurred  since  the 
epidemic  of  1881 — a  period  which  allowed  time  for  an 


92  THE  1907-1909  OUTBREAK 

abundant  non-immune  population  to  grow  up.  It  shows 
conclusively  that  if  the  black  race  is  protected  from 
yellow  fever,  it  becomes  quite  as  sensitive  to  the  disease 
as  the  latest  arrival  from  Europe. 

A  considerable  proportion  of  the  cases  occurred 
amongst  children  and  young  adults.  Upon  the  86  basis, 
the  number  of  deaths  recorded  is  36,  equal  to  a  death- 
rate  of  42  per  cent. 

The  Diagnosis  of  the  Early  Cases. — The  question 
naturally  arises  :  Do  the  notified  cases  represent  the  true 
total  of  all  cases  ?  In  my  opinion,  the  answer  here  is  the 
same  that  has  to  be  given  in  all  these  outbreaks  :  that  in 
all  probability  there  were  many  other  cases  which  were 
not  correctly  diagnosed.  There  was  a  divergence  of 
opinion  amongst  the  medical  men  as  to  whether  the 
cases  were  yellow  fever  or  not,  and  the  Press  was  not 
slow  to  make  use  of  this  want  of  unanimity  during  the 
outbreak ;  cases  of  illness  were  diagnosed  as  gastric 
influenza,  epidemic  jaundice,  malignant  jaundice,  and 
dengue.  Of  course  these  diagnoses  were  made  in 
absolute  good  faith  by  competent  medical  men  ;  but  for 
all  that,  there  may  have  been  mistakes,  and  some  of  the 
cases  might  have  been  yellow  fever.  I  gather,  from  my 
conversations  with  the  medical  men,  that  this  was 
indeed  probably  what  did  occur.  I  mention  these 
difficulties  because  they  invariably  happen  in  practice, 
and  because  they  demonstrate  the  absolute  necessity  of 
a  medical  head  in  the  colony  who,  by  virtue  of  his 
position,  can,  when  he  deems  it  advisable,  bring  about 
the  formation  of  a  friendly  consultative  committee  of  the 
medical  men  of  the  colony  to  act  as  a  jury  in  matters  of 


DIFFICULTIES  OF  DIAGNOSIS  93 

such  grave  importance  as  yellow  fever.  One  man  cannot 
know  everything  about  every  disease,  consultative  com- 
mittees are  therefore  absolutely  essential  on  certain 
occasions,  and  why  not  ?  Further,  it  is  very  disquieting 
to  neighbouring  colonies  if,  when  a  disease  is  diagnosed 
as  gastric  influenza,  it  leaks  out  that  black  vomit  and  a 
high  mortality  are  characteristic  of  it.  The  neighbouring 
colonies,  with  the  best  opinion  in  the  world  of  the  good 
faith  of  the  colony  with  such  a  remarkable  form  of 
gastric  influenza,  are  nevertheless  entitled  to  smile,  and 
to  insist  upon  rigorous  quarantine  measures ;  it  is,  after 
all,  but  business. 

The  Difficulties  of  Diagnosis  from  other  Diseases. — 
That  the  medical  profession  found  considerable  difficulty 
in  diagnosis,  the  following  memoranda  amply  prove  : — 

Mild  Cases, — Extracts  from  the  Quarterly  Sanitary 
Reports  of  the  parochial  medical  officers  re  yellow 
fever : — 

Dr  T.  S.  Brown,  No.  1  District,  St  Michael,  Slst  March 
1908. — During  this  quarter  I  have  attended  29  cases  of 
fever,  lasting  as  a  rule  from  three  to  five  days  :  one  case 
of  yellow  fever  occurred  in  my  district  on  which  a  post- 
mortem was  made,  and  it  was  duly  notified.  Several  of 
these  cases  presented  some  symptoms  of  yellow  fever,  and 
I  recognised  them  as  those  which  in  the  epidemic  of 
yellow  fever  in  1881  were  called  "tfebricula,"  and  were 
then  considered  by  the  medical  men  who  saw  that 
epidemic,  as  very  mild  cases  of  yellow  fever,  as  the 
initial  symptoms  were  the  same  as  those  in  which  yellow 
fever  afterwards  developed.  Some  medical  men  have 
considered  these  cases  to  be  "  gastric  influenza,"  but  as 
no  severe  type  of  influenza  was  present  while  these  cases 
occurred,  I  fail  to  see  how  "gastric  influenza"  can  be 


94  THE  1907-1909  OUTBREAK 

associated  with  these  cases.  Further,  if  they  were  of  the 
nature  of  influenza,  we  would  have  had  thousands  of 
these  cases  instead  of  the  few  cases  that  did  occur,  as  the 
swiftly  spreading  and  sudden  invasion  of  influenza  is  well 
known.  It  should  be  noted  that  when  cases  of  gastric 
influenza  recently  occurred  in  England,  there  was  at  the 
same  time  an  epidemic  of  influenza  of  the  ordinary  kind, 
which  affected  the  nasal  and  respiratory  parts  with 
which  influenza  is  generally  associated. 

Dr  E.  G.  W.  Deane,  No.  2  District,  St  Michael, 
31.9^  March  1908. — During  the  quarter  several  cases  of 
gastric  influenza  have  occurred  in  my  district ;  in  fact, 
I  may  say  that  we  have  had  an  epidemic  of  this 
disease. 

Dr  C.  E.  Gooding,  St  Philip,  ^\st  March  1908.— On 
30th  January,  a  boy  named  Hezekiah  Sargeant  was 
brought  to  the  dispensary  from  near  East  Point.  He  had 
been  ill  for  four  or  six  days  with  headache,  pains  about  the 
body,  particularly  the  stomach,  fever  and  persistent 
vomiting,  and  this  for  the  previous  twenty-four  hours 
had  consisted  of  a  dark  fluid  like  ''coffee  grounds." 
The  boy  looked  very  ill  indeed,  lying  in  a  state  of  stupor, 
noticing  nothing,  and  had  to  be  roused  to  answer 
questions.  His  eyes  were  tinged  with  yellow,  tempera- 
ture 108"6°  R,  pulse  72.  He  had  characteristic  "black 
vomit,"  without  any  effort  marked  tenderness  in  the 
epigastrium,  and  his  urine  contained  about  one-third  of 
albumen.  As  his  case  was  a  typical  one  of  yellow  fever, 
I  sent  him  back  home,  and  got  Dr  John  Hutson  to  see 
him  with  me  the  same  afternoon,  when  he  concurred  in 
the  diagnosis,  and  the  boy  was  sent  to  Pehcan  Island 
early  next  morning,  where  he  subsequently  died.  A 
couple  of  days  after,  his  brother,  John  Sargeant, 
developed  similar  symptoms,  and,  along  with  a  little  girl 
living  in  a  neighbouring  house,  was  also  removed  to 
Pelican   Island.       On    15th  February   I   saw  another 


"GASTRIC  INFLUENZA"  95 

typical  case  of  j^ellow  fever,  in  a  girl  named  Clemintina 
Cordeaux,  living  near  Well  House  (who  afterwards 
died).  She  was  also  seen  by  Drs  Philhps  and  Boxill. 
Since  then  I  have  sent  two  other  cases  to  Pelican 
Island.  ...  A  few  days  after  there  were  two  suspicious 
(mild)  cases  in  Alleyne's  house  in  Games  Land.  Since 
that  date,  I  am  glad  to  report  that  no  fresh  cases  have 
been  met  with. 

Altogether  I  have  met  with  five  typical  cases  of 
yellow  fever,  with  every  cardinal  symptom  well  marked, 
and  three  suspicious  cases.  ...  Of  the  five  typical  cases, 
the  diagnosis  of  two  was  agreed  to  by  Drs  Hutson, 
Phillips,  and  Boxill.  Four  were  coloured  and  one 
white. 

Four  were  sent  to  Pelican  Island,  where  one  died, 
and  I  think  I  am  right  in  saying  that  a  different 
diagnosis  was  there  made  in  all  the  cases. 

The  following  very  interesting  account  of  gastric 
influenza  has  been  kindly  furnished  me  by  a  consulting 
physician  residing  in  Barbados  : — 

Gastric  Influenza. — The  term  "gastric  influenza" 
has  been  applied  by  some  medical  men  in  Barbados 
during  the  last  year  to  cases  which  other  medical  men 
regarded  and  notified  as  genuine  yellow  fever. 

I  say  this  without  hesitation,  because  one  man  saw 
two  cases  and  another  man  one  case  in  consultation 
with  me,  which  were  all  regarded  by  two  other  men  and 
myself  as  undoubted  yellow  fever.  These  were  all  fatal 
in  from  three  to  five  days  in  white  persons,  with  early 
albuminuria,  lemon-coloured  urine,  suppression  of  urine, 
black  vomit,  and  yellow  discoloration  of  the  body- — 
slight  during  life,  and  pronounced  after  death.  One  of 
these  cases  was  verified  by  a  post-mortem  examination, 
which  revealed  a  typical  "box-wood"  liver,  stomach 
showing  arborescent  congestion  and  containing  black 
fluid.    Other  fatal  cases  characterised  by  "  black  vomit " 


96  THE  1907-1909  OUTBREAK 

were  heard  of  from  time  to  time,  which  were  not  notified, 
and  which  were  commonly  spoken  of  as  "gastric 
influenza." 

One  merchant  reported  that  he  had  private  informa- 
tion of  cases  exactly  similar  which  had  occurred  in 
Liverpool,  and  another  merchant  had  information  of 
cases  seen  by  his  son  in  one  of  the  London  hospitals 
which  his  son  informed  him  were  identical  with  the 
Indefatigable  cases  he  had  seen  here.  The  general 
public  believe  that  "  gastric  influenza "  was  a  separate 
disease,  hardly  distinguishable  from  yellow  fever,  which 
required  a  high  degree  of  medical  skill  to  diagnose,  and 
that  the  medical  men  who  were  diagnosing  yellow  fever 
were  ignorant  fools,  or  worse. 

The  following  extract  from  a  letter  of  a  medical 
friend  in  a  neighbouring  island  is  interesting.  He 
says : — 

We  are  disquieted  by  the  numerous  reports  we 
have  from  Barbados.  I  understand  from  letters  that 
the  laity  there  freely  laugh  about  the  new  name  for 
yellow  fever. 

We  hear  that  gastric  influenza  is  usually  or  always 
fatal,  and  always  has  black  vomit.  We  learn  that  it  is 
rather  widespread  in  the  island.  We  can  do  nothing  to 
prevent  its  introduction  again,  after  our  successful 
efforts  to  keep  it  down  so  far. 

Epidemic  Jaundice,  Weil's  Disease.  —  Dr  F.  F. 
M 'Donald,  who  has  had  the  advantage  of  personal 
experience  of  this  disease  in  Australia,  furnished  me 
whilst  in  Barbados  with  the  following  notes  regarding 
this  disease.     Dr  M'Donald's   experience   of  epidemic 


EARLY  NOTIFICATION  97 

jaundice,  or  Weil's  Disease,  was  gained  during  an 
epidemic  which  passed  through  a  camp  of  5000  people 
in  New  South  Wales.  The  chief  symptoms  were : 
acute  fever,  of  sudden  onset ;  lumbar  pain ;  vomiting  ; 
abortion  in  pregnant  women.  There  is  often  consider- 
able mortality.  The  disease  may  be  very  sudden,  and 
has  suggested  such  diagnosis  as  toxaemia,  hsemorrhagic 
septicaemia,  uraemia.  Its  epidemic  character,  high 
temperature  and  slow  pulse,  together  with  vomiting  and 
jaundice,  make  it  liable  to  be  confused  with  yellow  fever. 

Malaria. — In  Barbados,  unlike  in  other  yellow  fever 
countries,  a  difficulty  of  diagnosis  between  yellow  fever 
and  malignant  types  of  malaria  did  not  arise. 

Dengue  and  Dandy  Fever. ■ — This  fever  did,  however, 
cause  considerable  difficulty  in  diagnosis,  and  from  my 
conversation  with  medical  men,  there  can  no  longer  be 
any  doubt  that  cases  which  were  diagnosed  as  dengue 
fever  were,  in  reality,  cases  of  yellow  fever. 

Early  Notification :  Timidity,  Prejudice,  and  Opposi- 
tion.— As  in  my  British  Honduras  report,  so  in  this 
one,  I  seriously  direct  attention  to  the  difficulties  of 
early  notification.  These  difficulties  have  been  encoun- 
tered in  an  aggravated  form  in  British  Honduras  and 
in  Central  and  Southern  American  ports  generally. 
There  is  no  question  in  my  mind  that  a  considerable 
amount  of  odium  is  liable  to  be  incurred  by  a  medical 
officer  who  has  the  courage  to  declare  a  case  of  yellow 
fever. 

This  unsatisfactory  state  of  affairs  is  often  owing  to 
the  fact  that  there  are  usually  to  be  found  medical  men 
who,  without  having  themselves  examined  the  particular 


98  THE  1907-1909  OUTBREAK 

case,  nevertheless  make  up  their  minds  that  it  is  not 
yellow  fever,  but  some  other  simple  disease,  of  v^hich 
they  have  had  in  their  practice  many  cases.  This 
gives  the  Press  an  opportunity,  if  so  minded,  to  vilify  the 
first  medical  officer  who  notifies,  and  even  to  hint  that 
he  knows  nothing  about  the  disease,  whilst  at  the  same 
time  lauding  the  particular  medical  man  who  has  given 
the  opinion  which  is  the  more  palatable,  and  therefore 
probably  more  in  accord  with  the  views  of  the  news- 
paper. These  tactics  constitute  a  veiled  form  of  intimi- 
dation, and  are  destructive  in  the  long  run  to  the 
reputation  of  any  colony  for  fair  play  and  honesty. 

It  is  with  very  great  regret  that  I  am  obliged  to 
state  that  there  was  considerable  opposition  encountered 
in  Barbados  from  a  particular  section,  directed  to 
thwarting  and  ridiculing  those  who  were  acting  in  the 
very  best  interests  of  the  community  by  insisting  upon 
early  notification  of  suspected  cases. 

Whilst  in  British  Honduras  in  1905,  I  observed  the 
same  spirit;  but  I  had  expected  a  more  enlightened 
policy  from  the  Press  of  Barbados,  as  in  the  meantime 
an  enormous  stride  had  been  made  in  tropical  sanita- 
tion, and  I  expected  an  enlightened  Press  to  have  kept 
up  with  the  development.  Unfortunately  the  analysis 
of  the  articles  in  one  particular  journal,  published  in 
Barbados,  shows,  as  will  be  seen,  a  retrogressive  attitude, 
and  one,  moreover,  which  cannot  fail  to  do  harm  to  the 
reputation  of  the  colony  for  progression,  especially  as  in 
the  West  Indies  there  is  more  than  one  rival  for  the 
tourist  traffic,  besides  competitors  for  the  coaling  and 
other  trades.     It  might  be  argued,  as  it  was  done  in 


NOTIFICATION  FEAR  99 

this  case,  that  the  journal  in  question  was  a  quantite 
n4gligeable  and  did  not  represent  any  body  of  opinion. 
That  may  be  so  :  I  can  most  certainly  say  that  I  found 
all  classes  of  society,  and  notably  the  poorer  people, 
exceedingly  desirous  of  helping  in  every  way.  It  was 
one  of  the  greatest  elements  of  encouragement  which  I 
got  during  my  stay.  But  that  there  should  still  exist 
in  a  colony  which  desires  to  come  up-to-date,  not  only 
a  reactionary  newspaper,  but  one  which  discourages  the 
modern  methods  of  prophylaxis,  and  even  goes  further 
and  heaps  up  ridicule  upon  and  even  threatens  medical 
men  who  do  their  duty,  thereby  using  a  system  which 
flavours  of  intimidation,  can  only  be  regarded  as  a 
calamity,  for  it  is  calculated  most  assuredly  to  under- 
mine the  reputation  for  honesty  in  the  matter  of 
immediately  notifying  all  cases  of  a  quarantinable 
disease.  In  consequence,  adjacent  colonies  receive  with 
some  degree  of  doubt  the  statements  from  Barbados — a 
matter  to  which  I  shall  again  have  occasion  to  refer. 

Opinions  will  always  differ,  as  I  have  already  stated, 
as  to  the  diagnosis  of  the  earliest  and  mild  cases  in 
epidemics  of  yellow  fever  and  probably  in  all  fevers ;  for 
this  reason  it  becomes  imperative  for  every  colony  to 
possess  a  medical  head  who  can  summon  to  his  assist- 
ance, if  necessary,  a  trustworthy  group  of  medical  men, 
who  will  act  as  a  consultative  board.  Had  this  been 
done  in  Barbados,  that  colony  would  have  saved  many 
thousands  of  pounds  and  much  waste  of  life.  Those 
who  have  had  experience  in  yellow  fever  know  the 
difficulty  of  diagnosis  in  the  early  stages,  so  that  there 
is  no  stigma  attaching  to  the  medical  man  who  fails  to 


100  THE  1907-1909  OUTBREAK 

diagnose  a  case.  But  from  the  point  of  view  of  health 
administration,  it  is  in  the  doubtful  mild  cases  where  the 
greatest  care  and  judgment  is  necessary,  and  the  best 
way  to  meet  the  contingency  is  to  have  a  principal 
medical  officer  and  a  consultative  emergency  board. 

A  more  serious  difficulty  in  the  way  of  early 
notification  is  the  odium  which  is  too  apt  to  attach  to 
the  medical  man  who  diagnoses  such  serious  diseases  as 
yellow  fever,  smallpox,  or  plague.  Popular  opinion  in  a 
colony  is  against  admitting  that  any  such  diseases  are 
in  their  midst.  Experience  throughout  the  world,  and 
from  the  earliest  times,  teaches  us  that  this  is  so. 
Moreover,  the  bias  of  the  commercial  man  of  any  town 
would  be  against  admitting  that  such  diseases  are 
present.  It  is  for  this  reason  that  it  is  a  questionable 
advantage  to  have  too  many  laymen  upon  health  and 
quarantine  boards.  Where  there  is  no  P.M.O.  they 
are,  in  my  opinion,  a  positive  danger,  because,  with 
the  very  best  intentions,  laymen  are  quite  unable  to 
assess  the  difficulties  which  must  arise  in  questions 
involving  early  diagnosis  amongst  medical  men,  and 
they  are  naturally  inclined  to  favour  a  policy  which 
keeps  the  commerce  of  the  port  open  and  unrestricted. 
It  is  still  more  disastrous  if  the  newspapers  of  a  colony 
take  sides  and  by  innuendo  and  fomenting  public  opinion 
tend  to  bring  discredit  on  those  who,  having  the 
courage  of  their  opinions,  venture  on  such  a  momentous 
diagnosis  as  yellow  fever,  plague,  or  smallpox.  A 
young  practitioner  or  junior  medical  officer  of  health 
is  unquestionably  apt  to  be  deterred  from  the  execution 
of  his  duties  by  the  stirring  up  of  such  popular  opinion. 


INTIMIDATION  101 

In  Barbados  we  have  positive  evidence,  in  the  form  of 
a  series  of  articles  which  appeared  in  one  particular 
journal,  that  this  hostile  opinion  did  exist  during  the 
recent  epidemic.  I  append  the  following  examples,  so 
that  in  future,  colonies  may,  in  the  interest  of  public 
health,  avoid  this  most  insidious  evil  and  intimidatory 
policy. 

A  boy.  Sergeant,  was  suffering  from  a  suspicious 
illness  ;  there  was  a  difference  of  opinion  amongst  the 
medical  men  who  attended  the  case,  and  one  of  them 
ventured  to  diagnose  yellow  fever,  and  this  is  how  he 
was  regarded  in  the  eyes  of  more  than  one  newspaper : 

"  The  Agricultural  Reporter  "  Saturday,  8th  February 

1908. — The  result  of  the  enquiry  conducted  by  Dr , 

the  health  officer,  and  Dr ,  into  the  cause  of  death 

of  a  boy  named  Sergeant,  who  was  sent  to  the  Pelican 
Island    Hospital    from    Golden    Drive,    St    Phihp,    by 

Dr ,  on  Friday,  31st  January,  and  who  died  there 

on  the  night  of  the  same  day,  is  to  the  effect  that 
toxaemia  was  the  cause  of  death.  The  case  was  not 
one  of  yellow  fever.  Dr  ,  although  not  com- 
missioned to  take  part  in  the  enquiry,  obtruded  him- 
self and  fought  hard  to  get  the  case  declared  one  of 
yellow  fever.  Fortunately,  the  commissioned  officers 
were  not  plastic  tools  in  the  hands  of  this  alarmist 
and  quarantine-monger. 

Again,  we  read  in  the  Barbados  Bulletin  of  8th 
February  1909,  under  the  heading  "Arrogant  Pre- 
tensions "  : — 

The     overweening    self-importance,    the    arrogant 

pretensions   of  this   functionary,   Dr ,    have   time 

and  again,  ere  now,  been  paraded  in  the  public  press, 
but  the  particular  incident  which  prompts  this  article, 


102  THE  1907-1909  OUTBREAK 

and  which  seems  to  cap  the  climax,  took  place  on 
Wednesday  last.  On  that  day,  as  was  mentioned  in 
yesterday's    bulletin,   a   Medical    Board    consisting   of 

Dr  ,  Dr ,  and  Dr ,  met  to  investigate 

the  cause  of  the  death  of  a  man  named  Sergeant,  a 
resident  at  East  Point,  St  Philip.  We  presume  it 
will  be  readily  admitted  by  all  persons,  that  the  names 
here  given  suffice  to  indicate  this  Board  to  have  been 
a  thoroughly  competent  one  to  deal  with  the  question 

at  issue.     Not  so,  however,  thought  " ,"  alias 

Dr ;  for,  all-uninvited,  he  arrogated  to  him- 
self the  right  to  sit  on  this  enquiry,  take  part  in  the 
deliberations,  and  even  to  pit  his  medical  lore,  single- 
handed,  against  that  of  his  three  confreres  combined ; 
for  while  they  declared  the  case  to  be  one  of  jaundice, 
he  discovered  that  it  was  yellow  fever.  A  few  days 
previously  he  had,  in  opposition  to  the  opinion  of 
another  medical  man,  made  a  similar  discovery  or  in- 
vention with  respect  to  another  case  on  which  he  had 
sat  in  judgment,  and  the  neighbouring  colonies  were 
notified  to  that  effect. 

Now,  we  have  not  the  remotest  desire  to  witness  any 
imitation  by  our  Government  and  Health  Authorities 
of  the  dishonourable  policy  adopted  in  such  matters 
by  Trinidad,  and  which  has  been  so  severely  denounced 
here,  and  indeed  throughout  all  the  West  Indies.  If  it 
be  the  will  of  Providence  to  afflict  us  with  a  real  visita- 
tion of  yellow  fever  or  any  other  epidemic,  the  chastise- 
ment will  doubtless  be  accepted  by  all  classes  without 
murmur  or  complaint,  despite  any  inconvenience  or 
suffering  it  may  entail  upon  us ;  and  for  the  national 
honour  we  would  advocate  a  prompt  notification  thereof 
to  all  parties  concerned.  But  in  view  of  the  magnitude 
of  the  evil  involved,  the  importance  of  the  interests  at 
stake,  we  must  certainly  protest  with  all  vehemence  we 
can  command  against  this  extravagant  presumption  on 

the  part  of  Dr ,  who  appears  not  only  to  claim  to 

himself  the  right  of  laying  this  colony  under  quaran- 


INTIMIDATION  AND  THREATS  103 

tine,  but  also  seems  possessed  of  a  consuming  desire  to 
put  that  prerogative  into  operation.  In  the  words  of 
the  Egyptians  to  Pharaoh,  when  they  complained  of  the 
stubbornness  of  their  king  in  refusing  to  accede 
to  the  demands  of  Moses,  by  whom  the  ruin  of  their 
country  was  being  steadily  wrought,  we  ask  with 
reference  to  this  consummate  crank  and  faddist,  who 
seems  bent  upon  ruining  the  trade  of  the  colony : 
"  How  long  shall  this  man  be  a  snare  unto  us  ? "  How 
long  shall  we  be  exposed  to  the  risk  of  being  placed 
under  quarantine  at  the  ipse  dixit  of  a  Sir  Oracle,  the 
opening  of  whose  mouth  must  be  accepted  as  the  signal 
of  immediate  and  absolute  silence  on  the  part  of  every 
one  ?  Problems  that  involve  the  welfare  of  a  whole 
community  are  generally  found  to  be  very  difficult  of 
solution  ;  but  fortunately  for  us,  the  present  one,  though 
of  such  great  importance,  is  capable  of  a  very  easy 
settlement.  The  office  that  rejoices  in  the  grandilo- 
quent title  of  Poor  Law  Inspector,  is,  and  has  always 
been,  naught  but  a  sinecure,  and  its  immediate  abolition 
would,  we  feel  convinced,  extort  from  no  one  save,  of 
course,  its  present  incumbent,  a  rending  of  garments  or 
gnashing  of  teeth.  We  would  therefore  earnestly 
counsel  the  powers  that  be  to  lose  no  time  in  striking 
it  out  of  existence,  and  sending  this  evil  genius  of  ours 
to  earn  his  livelihood  as  a  private  practitioner,  in  which 
position  he  would  probably  not  have  so  much  oppor- 
tunity to  gratify  the  insane  ambition  by  which  he  seems 
to  be  possessed,  of  being  the  principal  agent  in  working 
out  his  country's  woe.     More  anon. 

The  medical  man  whom  the  newspaper  asks  the 
authorities  to^  lose  no  time  in  getting  rid  of,  is  the 
gentleman  who,  owing  to  his  experience,  was  deputed 
by  the  Board  of  Health  on  Jan.  6,  1909,  to  make  an 
investigation  into  the  sanitary  conditions  of  the  island, 
and  whose  report  was  the  only  official  statement  of  the 


104  THE  1907-1909  OUTBREAK 

epidemic  with  which  I  was  furnished  by  the  Govern- 
ment of  the  colony  and  by  the  Colonial  Office.  Yet, 
because  he  ventures  to  make  what  appeared  to  be 
an  unpopular  diagnosis,  he  is  threatened  with  grave 
penalties ! 

In  the  leading  article  of  the  Agricultural  Reporter 
of  11th  January  1909,  the  following  occui's : — 

The  parish  of  St  Lucy  referred  to  above,  is 
apparently  a  gross  offender  in  the  matter  of  this  yellow 
fever,  and  the  Board  of  Health  would  seem  to  be 
disposed  to  make  an  enquiry  into  the  state  of  affairs  up 
north.     But  what   is   surprising   is  to   find  the  Board 

commissioning  Dr to  go  up  there,  enquire 

into  the  sanitary  conditions  prevailing,  and  to  make 
suggestions  for  improvements.  This  makes  one  doubt 
the  sincerity  of  the  Board  of  Health,  No  doubt  this 
learned  little  man  will  make  a  voluminous  report  and 
display  a  vast  deal  of  knowledge.  But,  in  view  of  his 
well-known  predisposition  to  perceive  yellow  fever, 
copious  recommendations,  numerous  feats  to  be  per- 
formed under  supervision  of  medical  men,  the  expenditure 
of  thousands  of  pounds,  and  the  result,  as  is  usual  with 

Dr 's   schemes   and   plans — Nil.      The   Board    of 

Health  should  know  this.  Om*  advice  is  that  Trade 
should  make  a  truce  with  Medicine.  European  and 
American  visitors  on  the  island  are  not  at  all  alarmed. 
Why  need  they  be  afraid  of  a  yellow  fever  that  prefers 
the  blacks  to  the  whites  ? 

The  Agricultural  Reporter  of  22nd  January  1909, 
in  its  leader  on  the  outbreaks  in  the  parish  of  St  Lucy, 
states  : — 

For  some  time  past  there  has  been  a  disposition 
on    the   part   of   a    section    of    our    medical   men   to 


THE  PRESS  AND  NOTIFICATION  105 

discover  yellow  fever.  To  this  end,  diseases  which 
other  medical  men  have  recognised  and  diagnosed  as 
of  a  dififerent  kind,  have  been  declared  to  be  yellow 
fever  by  the  industrious  discoverers.  Despite  their 
best  eJBforts,  however,  the  disease  would  not  catch  on. 
It  would  not  become  epidemic.  It  would  not  attack 
and  kill  a  sufficient  number  of  people,  and  so  become  a 
respectable  and  profitable  disease  until  it  reached  the 
northern  parish  of  St  Lucy.  There  the  disease  behaved 
in  a  sufficiently  malignant  manner  to  win  the  approval 
of  the  pro-yellow  fever  party. 

It  is  alleged  to  have  attacked  some  24  persons,  and 
killed  7  of  them.  This  meant  that  the  business  had 
sufficiently  developed  to  attract  special  attention  from 
the  General  Board  of  Health.  And,  of  course,  the  first 
thing  that  this  authority  thought  of  doing  was  to  com- 
mission Dr to  go  down  to  St  Lucy  and  enquire 

into  the  situation. 

Comment  upon  the  injury  which  articles  of  this 
nature  are  likely  to  produce  in  the  minds  of  the  poorer 
and  more  ignorant  classes  is  useless.  A  real  injustice 
is  done  to  the  sanitary  reputation  of  the  colony,  and 
the  good  name  of  the  colony  in  other  directions  is  also 
bound  to  be  affected.  In  my  opinion,  these  newspaper 
articles  constitute  the  only  black  cloud  in  the  history  of 
the  1907-1909  epidemic  in  Barbados,  and  it  is  earnestly 
to  be  hoped  that  a  more  healthy,  honest,  and  mutually 
co-operative  spirit  will  prevail  in  future,  and  that  the 
Press  will  do  all  in  its  power,  by  means  of  reasoned 
articles,  to  show  the  world  what  a  beautiful  and  healthy 
island  they  possess. 

Complaints  hy  other  Colonies  of  the  Tardy  Notification 
of  Yellow  Fever  hy  Barbados,  etc. — Both  British  Guiana 
and   St   Lucia   drew    the   attention   of    the   Barbados 


106  THE  1907-1909  OUTBREAK 

administration  to  the  dangers  to  which  they  were 
exposed  by  the  failm^e  of  Barbados  to  notify  at  once. 
The  answers  which  were  received,  as  I  point  out  in  the 
chapters  deahng  with  British  Guiana  and  St  Lucia,  were 
not  calculated  to  allay  their  fears.  They  served, 
however,  to  reveal  the  lack  of  medical  organisation  in 
Barbados. 

Race  Incidence. — The  fact  that  yellow  fever  attacked 
the  coloured  and  black  population  with  more  frequency 
than  the  white,  caused  much  sm-prise.  As  I  have 
previously  stated,  this  is  not  surprising,  for,  where  yellow 
fever  breaks  out  anew  after  a  long  period  of  absence,  all 
members  of  the  community,  irrespective  of  colom'  or 
race,  are  equally  liable.  This  fact  showed  that 
Barbados  had  been  singularly  free  from  yellow  fever  for 
many  years.  The  black  population  has  also  suffered  in 
the  recent  epidemic  in  Martinique,  and  in  the  days  of 
Blair  it  also  occurred,  but,  of  course,  with  less  frequency, 
as  then  yellow  fever  was  much  more  endemic  or  chronic 
than  it  is  to-day.  The  outbreak  which  has  just  gone 
through  Barbados,  had  it  taken  place  in  the  old  days, 
would  have  seized  all  newcomers  ivithout  exception: 
that  is  to  say,  all  the  non-immunes.  Of  course,  the 
children  of  the  black  and  coloured  population  would 
also  have  got  it,  but,  no  doubt,  it  would  have  passed 
unrecognised  in  them,  as  does  to-day  malaria  in  the 
natives  in  those  countries  where  malaria  is  endemic. 

In  order  to  show  the  striking  contrast  of  the  recent 
outbreak  of  fever  in  Barbados  to  what  happened  in  the 
days  gone  by,  it  is  recorded  that,  in  1805,  the  15th 
Foot  Regiment,  in  about  three  weeks,  soon  after  their 


PREVIOUS  EPIDEMICS  107 

landing  in  Barbados,  lost  110  men  and  7  officers.  In 
1821,  we  read  that  55  soldiers  and  very  many  of  the 
crew  of  the  frigate  the  Py ramus  were  admitted  into 
the  naval  hospital,  suffering  from  yellow  fever.  In 
1841,  we  learn  that  21  men  of  the  33rd  Regiment  died 
in  the  regimental  hospital  from  1st  October  to  15th 
December.  Sometime  about  1847,  the  88th  Eegiment 
suffered  severely  after  a  year's  residence ;  the  66th  after 
a  few  weeks,  and  the  72nd  after  about  ten  months' 
residence ;  the  natives,  on  the  contrary,  not  appearing  to 
suffer — of  course  not,  as  they  all  had  had  it  one  time  or 
another,  and  had  kept  up  a  constant  supply  of  infected 
Stegomyia,  which,  sooner  or  later,  were  bound  to  have 
opportunities  of  biting  the  non-immune  soldiers. 
Stronger  evidence  of  the  mosquito  origin  of  the  disease 
could  hardly  be  conceived.  By  no  other  means  could 
the  difference  of  the  recent  and  past  epidemics  be 
accounted  for. 

Periodicity  of  Epidemics. — Another  subject  which 
came  up  for  comment  in  connection  with  the  recent 
outbreak,  was  the  question  of  periodicity.  The 
authorities  seemed  to  realise  that  it  was  time  to  have 
an  epidemic,  as  epidemics  in  the  past  appeared  to  have 
occurred  at  regular  intervals.  There  is  absolutely 
nothing  in  it,  however,  though  the  older  writers  noted  it. 
Thus  Dr  Pavy,  editor  of  Blair  s  Work,  observes  :  "  A 
belief,  founded  on  partial  experience,  commonly  prevails 
in  the  West  Indies,  that  the  outbreak  of  yellow  fever 
there  is  periodic.  Its  recurrence  at  intervals  of  time 
may  be  considered  as  well  established ;  but  it  cannot  be 
admitted    to    be    equally    well    established   that    the 


108  THE  1907-1909  OUTBREAK 

intervals  are  regular  and  alike  so  as  to  admit  of  being 
calculated."  In  those  days  the  idea  was  that  a  traveller 
would  calculate  when  such  and  such  a  yellow  fever 
country  was  due  to  have  its  outbreak,  and  when,  in 
consequence,  it  would  be  unsafe  to  visit  it. 

The  Season  of  the  Year  in  which  the  Outbreak 
occurred. — The  season  may  be  summed  up  as  the  cool 
season;  in  this  respect  the  recent  outbreak  resembles 
previous  ones,  when  the  disease  was  ever  recurrent ;  it 
was  years  ago  observed  that  the  fever  most  frequently 
broke  out  at  a  time  when  the  season  was  most  agreeable 
and  favourable  to  health.  Again,  this  is  clearly  shown  in 
the  recent  epidemic,  for  the  general  death-rate  per 
thousand,  viz.,  10 "9,  was  lower  than  in  any  of  the 
previous  years. 

Nature  of  the  Measures  adopted  to  Check  the 
Outbreak.  —  It  having  at  last  dawned  upon  the 
Barbadians  that  they  really  had  yellow  fever  amongst 
them,  in  spite  of  the  many  reluctant  growls,  let  us 
enquire  what  was  done  to  meet  the  emergency  which 
had  arisen. 

In  the  first  place,  the  health  authority  of  the  island 
having  no  executive  medical  officer,  no  medical  officer 
of  health  whose  business  it  is,  as  in  all  civilised 
countries,  and  in  all  other  British  Possessions,  as  far  as 
I  am  aware,  to  report  regularly,  and  to  investigate  all 
outbreaks  of  disease,  asked  on  the  6th  January  1909  a 
member  of  their  Board  if  he  would  be  good  enough  to 
visit  one  of  the  parishes,  St  Lucy,  in  which  an  outbreak 
of  yellow  fever  had  occurred.  Dr  Hutson,  the  gentle- 
man who  volunteered,  made  a  report  (see  Appendix), 


FIRST  STEPS  109 

pointing  out  the  weak  places  in  the  defences  and 
making  recommendations  of  a  very  useful  kind.  This 
very  patriotic  action  of  Dr  Hutson  and  many  subsequent 
similar  acts,  instead  of  earning  the  grateful  thanks  of 
the  whole  community  for  his  having  at  once  volunteered 
to  assume  the  role  of  what  the  Board  should  have  had, 
viz.,  a  properly  salaried  medical  officer,  earned  for 
himself  instead,  as  we  have  seen,  bitter  abuse  of  a  not 
unimportant  section  of  the  Press  of  the  island.  When 
I  arrived  in  Barbados  on  March  1st,  Dr  Hutson's  report 
was  the  only  reasoned  document  which  the  Board  of 
Health  placed  in  my  hands  concerning  the  outbreak. 
No  detailed  investigation,  as  far  as  I  am  aware,  was 
made  into  the  origin  of  the  outbreak,  first  officially 
declared  19th  November  1907^that  is,  more  than  a  year 
previously.  I  was  not  furnished  with  any  detailed  and 
completed  report,  which  would  have  been  of  great  use  to 
me  in  my  investigations.  This  situation  undoubtedly 
discloses  an  extraordinary  state  of  affairs — the  total 
lack  of  a  medical  head  for  the  colony.  In  the  twentieth 
century  it  is  hard  to  realise  that  a  Legislative  Council 
would  have  rested  content  without  a  medical  adviser, 
especially  in  view  of  the  fact  that  they  had  numerous 
excellent  law  advisers,  and  that  by  having  a  medical 
adviser  they  would  only  be  following  the  rule  of  every 
civilised  community  throughout  the  world. 

Had  there  been  such  a  salaried  officer,  I  am 
convinced  that  just  as  in  the  case  of  St  Vincent  and 
Grenada,  the  fever  would  have  been  suppressed  at  a 
much  earlier  date,  and  very  much  more  money  saved 
than  that  represented  by  the  salary  of  such  an  officer. 


110  THE  1907-1909  OUTBREAK 

Further,  however,  as  Barbados  is  naturally  a  most 
healthy  island,  it  was,  in  my  opinion,  incumbent  upon 
the  Legislative  Council  to  keep  that  reputation  up  and 
to  publish  it  to  the  world,  for  much  of  the  prosperity  of 
the  island  depends  upon  its  sea  trade  and  its  attrac- 
tiveness to  visitors  seeking  health  and  rest.  Does 
anyone  in  their  senses  suppose  that  health  resorts  like 
Brighton,  Eastbourne,  E,amsgate,  or  Margate  would 
tolerate  the  abolition  of  the  posts  of  Medical  Officers  ? 
They  know  that  upon  them  naturally  rests  in  very  large 
measure  the  responsibility  of  the  health  security  of 
these  respective  health  resorts,  the  attractiveness  of 
which  is  very  largely  due  to  their  energy  and  vigi- 
lance. Similarly,  Barbados  has  everything  to  gain  by 
appointing  a  well- qualified  Medical  Officer  of  Health, 
whose  presence  in  the  island  would  co-ordinate  medical 
institutions  and  opinion,  and  who  would  be  ready  to 
advise  as  to  all  necessary  sanitary  reforms ;  above  all, 
whose  reports  and  ability  would  be  a  guarantee,  both  to 
business  men  and  the  travelling  public,  that  Barbados  is 
being  properly  looked  after.  Laymen  cannot  take  the 
place  of  gentlemen  who  have  been  trained  in  medicine 
and  sanitation,  any  more  than  medical  men  could  be 
expected  to  decide  and  advise  on  matters  of  law  or 
religion.  Without  such  a  duly  qualified  Medical  Officer 
of  Health,  Barbados  will,  in  my  opinion,  not  only  do 
itself  injustice,  but  will  positively  injure  its  reputation  ; 
the  recent  outbreak  is  overwhelming  proof  of  this.  I 
sincerely  trust,  therefore,  that  the  Legislature  will,  as 
a  first  step  towards  striving  to  keep  Barbados  the 
premier  health  resort  of  the  West  Indies,  make  this 


IIRST  STEPS  111 

appointment.  This  is  not  my  view  only,  it  is  the 
opinion  of  all  those  who  have  considered  the  question. 

There  having  been  no  medical  officer  when  yellow 
fever  was  declared,  what  steps  were  taken  to  grapple 
with  the  situation  ? 

On  4th  January  1909,  a  circular  (see  Appendix)  was 
issued  from  the  Board  of  Health  to  the  Commissioners 
of  Health  of  the  various  parishes,  drawing  their  atten- 
tion to  the  necessity  of  early  screening,  isolation, 
fumigation,  early  notification,  careful  surveillance  of 
contacts  and  destruction  of  larvse.  All  very  good  if 
only  a  medical  officer  had  been  there  to  see  that  they 
were  done.  On  14th  January  another  circular  was 
sent  out,  limited  to  the  parish  of  St  Lucy,  forbidding 
wakes. 

On  4th  February  a  circular  was  issued,  again  drawing 
attention  to  screening,  isolation,  and  fumigation,  etc. 
On  8th  February,  complaints  having  been  received  from 
sister  colonies,  and  foreign  consuls  having  complained  of 
the  slowness  of  notification,  a  circular  was  issued  to 
all  medical  practitioners  asking  them  to  report  all  cases 
directly  to  the  Board  of  Health. 

On  the  same  day  another  circular  was  issued  to 
Commissioners  of  Health  of  all  parishes,  acquainting 
them  that  the  Board  of  Health  had  decided  to  appoint 
a  central  inspector  to  inspect  the  island  day  by  day. 

The  various  parishes  were  also  asked  to  appoint 
more  inspectors.  Again  this  was  a  useful  move,  but  in 
the  name  of  common  sense,  why  was  not  the  all- 
essential  thing  done  and  a  medical  officer  appointed  ? 
The  sanitary  inspectors  are  most  worthy  and  excellent 


112  THE  1907-1909  OUTBREAK 

meu,  as  I  well  know,  but  it  was  unfair  to  thrust  upon 
them  the  duties  of  experienced  medical  men. 

On  the  18th  March  a  circular  was  issued  to  all 
medical  men,  asking  them  to  help  me  on  my  arrival  in 
any  way  they  could,  and  to  furnish  me  with  notes  of 
their  cases.  This  was  exceedingly  generous  and  wise ; 
but  it  shows  how  really  headless  and  armless  the  Board 
was.  In  any  other  community  the  Medical  Officer 
would  have  had  all  that  ready  as  a  matter  of  course. 

Useful  rules,  taken  from  the  Public  Health  Act  of 
1898,  for  dealing  with  cases  of  yellow  fever  were  also 
issued,  as  well  as  the  hints  upon  treatment  published 
by  John  Guiteras.  Handbills  were  widely  distributed, 
and  conspicuous  posters  were  aflSxed  in  all  prominent 
places,  containing  the  regulations  for  the  destruction  of 
mosauitos  as  enacted  in  the  Public  Health  Act  of  1898. 
These  are  excellent ;  all  they  wanted  was  an  active 
Medical  Officer  to  see  that  they  were  carried  out  to  the 
letter. 

Source  of  Infection. 

From  review  of  the  facts  in  connection  with  the 
epidemic,  I  concluded  that  yellow  fever  was  introduced 
into  the  colony  from  without.  It  now  remains  to 
enquire  whence  it  came. 

1.  Quarantine  Precautions. — Unless  a  town  knows  it 
is  free  from  Stegomyia,  there  should  be  no  relaxation  of 
the  strict  supervision  of  all  arrivals  from  yellow  fever 
countries.  This  is  well  illustrated  by  the  energetic 
and  searching  supervision  of  all  ships  arriving  from 
infected  ports,  which   the  United  States  Government 


QUARANTINE  LAXITY  113 

insists  upon.  I  had  practical  experience  of  this  super- 
vision, when  in  1905  I  travelled  much  on  the  ships 
of  the  United  Fruit  Company.  Not  only  did  the 
American  authorities  insist  upon  quarantine  and 
fumigation,  but  they  had  medical  officers  stationed  on 
the  look  out  at  all  fruit  ports  in  Central  America,  whilst 
a  medical  officer  usually  travelled  on  the  ships.  In  1906, 
British  Honduras  followed  this  example  with  very 
marked  success.  But  what  do  we  find  in  the  West 
Indies  ?  We  find  that  whereas  the  United  States 
Government  insists  upon  the  fumigation  of  ships  before 
discharging  at  certain  Southern  United  States  ports, 
where  there  is  a  danger  of  introducing  yellow  fever 
— that  is,  of  course,  through  ships  coming  from  infected 
countries — we  find,  extraordinary  to  relate,  that  the 
fumigation  has  been  usually  made  at  Barbados  or 
Castries !  thus  exposing  both  these  places  to  a  very 
great  risk.  No  doubt  the  reason  for  this  curious 
procedure  is  that  there  are  inconveniences  in  the  way 
of  fumigation  at  the  infected  ports  of  departure,  whilst 
at  Barbados  and  Castries,  where  less  rigid  views  prevail 
than  in  the  United  States,  ships  are  allowed  to  discharge 
and  have  intercourse  with  the  shore  and  to  fumigate, 
provided  they  have  clean  bills  of  health.  But  it  is  well 
known  there  is  a  risk  of  overlooking  mild  cases.  Mild 
cases  would  in  all  probability  be  diagnosed  as  malaria 
or  influenza,  and  would  not,  therefore,  be  regarded  as  at 
all  dangerous  or  justifying  rigid  quarantine  measures. 
But  we  know  from  experience  that  these  are  precisely 
the  cases  which  introduce  infection.  There  is  also,  of 
course,  the  danger  that  such  ships  may  carry  infected 

H 


114  THE  1907-1909  OUTBREAK 

Stegomyia^  whicli  may  either  get  ashore  or  more 
probably  infect  labourers  arriving  from  the  shore  who 
help  to  discharge  the  cargo.  Therefore  it  stands  to 
reason,  that  if  the  United  States,  which  is  much  farther 
away,  insist  upon  fumigation  of  vessels  sailing  from 
infected  countries,  is  it  very  much  more  necessary  for 
the  West  Indies  to  insist  upon  similar  action  before  the 
arrival  of  these  ships  in  their  ports.  It  is  no  part  of 
modern  quarantine  administration  to  make  commercial 
intercourse  difficult ;  it  is  designed  to  protect  com- 
merce by  lessening  the  risk  of  disease,  and  I  would 
recommend  that  in  the  case  of  all  ships  arriving  from 
places  where  we  know  yellow  fever  is  endemic,  that 
the  passengers  and  crew  should  be  carefully  examined 
by  the  port  medical  officer,  and  that  passengers  going 
ashore  should  be  kept  under  surveillance.  Of  course, 
when  the  towns  and  villages  of  the  West  Indies  have 
banished  the  Stegomyia,  the  risk  from  yellow  fever 
will  disappear,  and  it  need  not  be  feared  any  more  that 
it  is  in  Liverpool,  London,  or  New  York  to-day. 
There  is  another  reason  why  strict  quarantine  adminis- 
tration is  still  necessary,  and  that  is  on  account  of 
plague.  This  disease  is  travelling  to  the  West  Indies 
from  the  Pacific  side  of  the  American  continent,  and 
with  the  increased  communication  with  the  East  great 
care  is  still  necessary,  for  plague  is  not  so  easily  dealt 
with  as  yellow  fever,  and  much  more  stringent  measm^es 
against  rats  are  urgently  required.  It  happens  that  many 
of  the  countries  In  which  yellow  fever  is  endemic  are 
those  in  which  plague  has  made  its  appearance. 

From   evidence   placed  before  me   in  Barbados  by 


ORIGINAL  SOURCE  OF  INFECTION  115 

Dr  Bi'idger,  Port  Quarantine  Officer,  and  Dr  Hutson, 
an  observant  and  leading  physician  in  Barbados,  there 
appears  to  me  several  possible  sources  from  which 
infection  might  have  been  introduced,  either  through 
infected  man  or  through  infected  Stegomyia,  namely  : — 

1.  Martinique. — In  1908  there  was  a  sharp  epidemic 

of  yellow  fever ;  there  were  99  cases  reported 
and  20  deaths,  and  the  first  officially  notified 
case  was  on  22nd  June  1908.  Until  we  have  a 
full  official  report,  it  will  be  impossible  to  con- 
jecture whether  they  had  had  yellow  fever 
before  this  date  or  not ;  they  no  doubt  had  (see 
Appendix). 

2.  Surinam. — At  the  end  of  1908  there  was  yellow 

fever  in  this  Dutch  colony,  which  was  attacking 
new  arrivals. 

3.  Venezuela. — As  this  is  still  a  yellow  fever  strong- 

hold, and  poorly  organised  from  the  sanitary 
standpoint,  it  is  a  possible  som^ce  of  infection. 

4.  The  Amazon. — This  is  also  an  endemic  focus,  and 

unquestionably  it  is  also  a  possible  infecting 
source. 

5.  St  Vincent. — Five  cases  of  yellow  fever  occurred 

in  this  colony  towards  the  end  of  1908.  The 
disease  was  at  once  taken  in  hand  and  did  not 
spread.  In  my  opinion,  the  disease  was  intro- 
duced into  St  Vincent,  and  could  not  have  been 
endemic.  The  few  cases  are  of  great  interest, 
because  they  are  corroborative  evidence  that 
yellow  fever  infection  was  in  the  West  Indian 


116  THE  1907-1909  OUTBREAK 

zone,  and  that  Barbados  and  St  Vincent  were 
both  infected  from  an  outside  source.  It  is  not 
likely  that  St  Vincent  infected  Barbados,  but 
both  might  have  been  infected  from  a  common 
centre. 

6.  Trinidad. — In  January  1907,  yellow  fever  began 
to  occur  and  newcomers  were  attacked ; 
numerous  cases  were  reported  up  to  1909.  As 
a  case  was  notified  in  January  1907,  it  is 
reasonable  to  assume  that  infection  was  present 
in  Port  of  Spain  in  1906,  but  was  not 
recognised. 

Now  Trinidad,  as  we  shall  see  when  discuss- 
ing that  colony,  is  in  close  relationship  with 
Venezuela — a  yellow  fever  stronghold — and, 
as  it  appears  to  me  evident  that  yellow  fever 
has  been  in  Trinidad  at  least  since  1906,  there- 
fore it  is  quite  possible  that  Trinidad,  having  itself 
become  infected  from  Venezuela,  was  the 
unconscious  means  of  disseminating  the  disease 
to  other  islands. 

In  my  opinion,  the  recent  outbreak  in 
Barbados,  affecting,  as  it  did,  largely  the  black 
population,  is  striking  testimony  to  the  fact  that 
the  recent  outbreak  was  not  an  endemic  con- 
flagration ;  on  the  contrary,  the  disease  had 
been  so  long  absent  from  the  island  that  there 
had  been  time  for  the  growth  of  a  non-immune 
native  population. 

In  other  words,  the  native  had  become  as 


ENDEMIC  YELLOW  FEVER  117 

susceptible  to  the  disease  as  the  rawest  arrival 
from  Europe. 

In  a  country  where  yellow  fever  is  endemic,  as  for 
example,  places  on  the  Amazon  and  Orinoco,  or  as  in 
Barbados  itself — many  years  ago,  the  opposite  was  the 
rule — the  natives  are  immune,  and  do  not  suffer  in 
epidemics,  because  they  have  had  the  disease  when  they 
were  young,  and  in  such  a  mild  form  that  it  was  never 
diagnosed.  They  had,  in  other  words,  an  ambulatory 
form,  as  happens  so  frequently  in  the  case  of  many 
other  diseases.  The  non-immunity  of  the  natives  in 
the  recent  outbreak  coincides  with  the  evidence  that 
the  last  outbreak  was  in  1881 — that  is,  some  twenty-six 
years  before  the  present  one. 

With  regard  to  Trinidad,  I  have  shown  that  yellow 
fever  was  present  there  in  all  probability  in  1906.  Dr 
Hutson  has  kindly  given  me  his  own  reasons  for 
supposing  Trinidad  to  be  the  source.  They  are  as 
follows  : — 

"My  reasons,"  he  states,  "for  thinking  that  yellow 
fever  was  introduced  into  Barbados  from  Trinidad  in 
1907  are  that— 

1.  "Yellow  fever  had  been  prevailing  in  Trinidad 
during  many  months  of  1907,  and  after  the  notification 
of  cases  there  had  ceased,  the  Health  Officer  of  the 
port  of  Barbados,  with  marked  reluctance  signified  his 
intention  of  no  longer  carrying  out  the  restrictions 
prescribed  by  the  West  Indies  Convention  of  1905. 

2,  "  The  reluctance  of  the  Health  Officer  was  shared 
by  the  Board  of  Health  of  Barbados,  and  was  the  result 
of  continued  notices  in  the  press  of  Trinidad,  record- 
ing  the  deaths   of  newcomers   and   persons   of  short 


118  THE  1907-1909  OUTBREAK 

residence  in  the  colony  after  illnesses  of  a  few  days' 
duration. 

3.  "The  Board  of  Health  asked  the  Governor  to 
apply  to  the  Governor  of  Trinidad  for  medical  reports 
of  some  of  these  cases,  and  these  reports  by  no  means 
tended  to  allay  the  anxiety  felt  on  the  subject.  Several 
of  the  deaths  were  reported  to  have  been  from  '  malig- 
nant malaria,'  and  in  other  cases  the  reports  disclosed 
symptoms  that  suggested  the  probability  of  yellow 
fever. 

"It  may  be  added  that  during  the  outbreak  in 
Trinidad,  it  was  noticed  that  a  large  majority  of  the 
cases  of  yellow  fever  notified  in  Port  of  Spain,  Trinidad, 
were  certified  by  one  medical  man,  and  the  natural 
inference  was  that  as  he  could  not  possibly  be  attending 
the  whole  community  of  the  Port  of  Spain,  there  must 
be  many  other  cases  not  notified.  The  incidence  of 
the  cases  showed  also  that  practically  all  the  victims 
were  newcomers  from  northern  climates  with  periods 
of  residence  of  less  than  one  month  and  upwards." 

As  showing  the  possibility  of  infection  coming  from 
Trinidad,  the  following  memorandum  is  of  interest : — 

On  10th  August  1907,  Surgeon  Urquhart  of  the 
M.U.S.M.H.  service  reported  to  Washington  that  on 
31st  July  the  s.s.  Atrato  from  Trinidad  landed  a 
stowaway  suffering  from  yellow  fever. 

With  regard  to  the  Amazon,  there  is  regular 
communication  by  a  line  of  steamships  proceeding  on 
their  way  to  United  States  ports,  and  it  is  customary 
because  more  convenient  for  them  to  fumigate  either  at 
Barbados  or  St  Lucia.  This  is  done  on  account  of  the 
prevalence  of  yellow  fever  at  the  ports  of  departure 
on  the   Amazon,   and  because  certain   United   States 


YELLOW  FEVER  ON  THE  AMAZON  119 

ports  (Galveston,  for  example)  insist  on  fumigation. 
Apparently  Bridgetown  and  Castries  are  selected  as 
convenient  places  at  which  to  carry  out  the  fumiga- 
tion, for,  in  all  probability,  during  the  disagreeable 
process  of  sulphur  fumigation,  passengers  and  members 
of  the  crew  may  go  ashore  and  enjoy  themselves.  Now 
we  have  evidence  that  the  members  of  the  crew,  and 
passengers,  of  these  steamers  do  occasionally  contract 
yellow  fever  at  the  ports  of  departure. 

The  following  statement  shows  the  number  of  such 
cases  which  occurred  in  a  period  of  eighteen  months  in 
the  years  1908  and  1909  :— 

1.  A  fireman  contracted  disease  in  the  month  of 
August,  in  Manaos ;  it  was  of  a  malignant  type,  with 
early  black  vomit,  and  the  man  died  on  the  fourth  day. 

2.  A  fireman  developed  the  disease  in  Iquitos,  in 
the  month  of  December  1908 ;  early  albuminuria,  no 
black  vomit,  died  on  the  sixth  day. 

3.  A  steward  developed  yellow  fever  in  Iquitos, 
month  of  April,  of  a  similar  type,  and  recovered. 


4.  Steward  (death). 

do.      (death). 

do.      (death). 

do.      (recovery). 
Engineer  (death). 
Two  passengers  (recovery) 


Month  of  AprHl. 

All  contracted  the  dis- 
ease alongside  of  hulk 
used  as  a  storehouse  and 
station  for  labourers  going 
to  and  from  new  railway 
works  on  river  Madeira. 


Note. — All  ships  are  supplied  with  mosquito  nets, 
and  all  members  of  the  crew  must  use  them.  As  far  as 
possible,  gauze  doors  are  provided  for  the  officers  and 
engineers. 


120  THE  1907-1909  OUTBREAK 

The  lighters  of  the  company  are  periodically  cleaned 
and  their  bilges  injected  with  kerosene. 

After  every  case,  which  is  at  once  isolated,  the 
quarters  are  fumigated  twice  (with  a  twelve-day 
interval). 

All  the  above  cases  were  primary.  There  have 
been  no  secondary  cases  in  any  of  the  ships. 


Unless  there  have  been  suspected  cases  of  yellow 
fever  on  board,  fumigation  is  never  done  on  leaving  any 
infected  port.  It  is  therefore  not  unreasonable  to 
suppose  that  these  ships  may  carry  either  infected  mild 
cases  of  yellow  fever  or  infected  Stegomyia;  in  the 
former  case  if  such  an  infected  person  went  ashore  he 
would  infect  the  abundant  local  supply  of  Stegomyia; 
in  the  latter  case  if  lightermen  or  labourers  went  on  to 
the  ship  they  might  become  infected  from  infected 
Stegomyia  which  might  be  on  board  and  so  convey 
infection  ashore.  We  find  that  on  7th  December  1906 
Consul  Clare  reported  to  Washington  the  landing  of  a 
suspected  case  of  yellow  fever  from  the  s.s.  Maranhense, 
from  Para ;  the  ship  left  Para,  3rd  December  1909,  and 
arrived  at  Barbados  on  7th  December  1909;  the  ship 
reported  no  quarantinable  disease,  the  ship's  doctor 
regarding  the  case  as  e^ddently  one  of  malaria ;  no 
unusual  diagnosis,  and  not  more  amiss  than  the 
diagnosis  of  dengue  fever  in  the  case  of  the  sailors  of 
the  H.M.S.  Indefatigable.  The  Health  Ofiicer  in  charge 
at  Bridgetown  had  the  case  quarantined,  as  he  was  not 
satisfied  with  the  diagnosis.  But  it  appears  that  the 
other  passengers  were  allowed  to  land  !  The  distance 
by  time  from  Para,  Manaos,  or  Iquitos  on  the  Amazon 


YELLOW  FEVER  AND  THE  AMAZON  121 

to  Barbados  is  not  long,  occupying  from  four  and  a  half 
to  nine  days  from  the  nearest  and  farthest  ports 
respectively ;  so  that  one  of  the  crew  or  passengers 
infected  about  the  time  of  departure  might  arrive  in 
Barbados,  not  at  once  suggestive  of  yellow  fever,  but, 
nevertheless,  in  a  condition  capable  of  communicating 
infection  on  going  ashore  to  the  Stegomyia.  It  is  well 
known  that  the  Stegomyia  can  easily  survive  such  a 
short  voyage ;  therefore  I  consider  that  ships  arriving 
from  the  ports  on  the  Amazon  should  always  be  most 
carefully  examined,  and  should  be  fumigated  before 
contact  with  the  shore  is  permitted.  The  ships  should 
preferably  be  fumigated  at  the  port  of  departure  as  a 
routine  measure,  so  long  as  ports  on  the  Amazon  are 
not  put  in  proper  order  and  act  as  endemic  foci  of 
yellow  fever.  The  Amazon  is  to  Barbados  what 
Venezuela  is  to  Trinidad,  and  the  same  measures  of 
safety  should  be  adopted  in  both  colonies. 


CHAPTER   X 

HEALTH   PROGRESS   AND    ADMINISTRATION   IN   BARBADOS 

In  the  preceding  chapter,  and  also  in  Chapter  II.,  I  have 
given  an  account  of  the  terrible  mortality  from  yellow 
fever  in  Barbados  which  took  place  annually  up  to  the 
nineteenth  century,  when  sanitation  began  to  make  head- 
way, and  when,  above  all  things,  drainage  and  a  new 
wholesome  water-supply  took  the  place  of  the  old-time 
polluted  wells.  These  reforms,  as  I  have  said,  struck 
at  once  the  death-blow  to  cholera  and  all  water-borne 
infections,  and  were  the  factors  which  took  from  yellow 
fever  in  Barbados  its  endemic  character.  From  the  day 
when  a  pipe-borne  water-supply  was  laid  on,  yellow 
fever  receded. 

Immediately  upon  my  arrival  in  Barbados  I  organised 
a  house-to-house  inspection  in  Bridgetown,  with  the 
view  of  finding  out  the  distribution  and  number  of  the 
breeding  places  of  the  Stegomyia  calopus. 

Mosquito  Survey  and  General  Cleaning -up  in 
Barbados. — This  part  of  my  experience  in  Barbados 
was  the  most  pleasurable.  It  enabled  me  to  become 
acquainted  with  the  poorer  classes,  and  I  can  now 
testify  to  the  good  sense  and  good  temper,  and  to  the 

122 


H       (^ 


CLEANING  UP  123 

enthusiasm  shown  by  all  classes,  including  the  poorest, 
to  assist  in  the  work  of  cleaning  and  getting  rid  of 
mosquito  larvse.  It  was,  moreover,  on  these  rounds 
that  I  learnt  to — 

Be  to  their  faults  a  little  blind, 
But  to  their  virtues  very  kind. 

My  aim  was  to  instruct  the  householders  and  to  get 
them  to  come  into  line  of  their  own  free  will.  Taking 
all  things  into  consideration,  especially  the  novelty  and 
strangeness  to  them,  of  waging  war  upon  that  which  all 
their  lives  they  had  looked  upon  as  harmless,  namely, 
the  wiggle-waggles  or  worms,  as  they  called  the 
mosquito  larvae,  they  took  in  excellent  part  our  up- 
setting their  water-casks  and  water-receptacles ;  indeed 
I  have  many  times  seen  them  overcome  by  the  sense  of 
shame  when  we  found  worms  in  their  water.  It  was  as 
objectionable  to  them  as  in  England  the  finding  of  bugs 
in  a  bed  would  be. 

Another  pleasing  feature  on  these  rounds  was  that 
I  was  accompanied  by  the  Chairman  of  the  Sanitary 
Commissioners  of  Bridgetown,  St  Michael's,  my  friend 
the  active  Mr  Graham  Yearwood,  my  colleague  Dr 
Hutson,  and  a  goodly  array  of  sanitary  inspectors, 
including  Messrs  Brewster,  Williams,  and  Cumberbach, 
with  their  assistants.  They  were  all  untiring  in  ad- 
monishing and  reasoning  with  the  people.  I  remember 
upon  one  occasion  when  an  old  lady  remonstrated  with 
Mr  Brewster  that  worms  could  not  possibly  do  any 
harm,  the  good-tempered  inspector  silenced  the  argu- 
ment by  retorting  :  "  Madam,  I  too  once  believed  as  you 


124 


HEALTH  PROGRESS  IN  BARBADOS 


do."  Upon  another  occasion,  when  I  discovered  larvae 
in  a  flower  vase,  the  lady  of  the  house  was  so  annoyed 
at  her  negligence  that  she  smashed  the  vase  in  pieces, 
with  the  exclamation  that  that  vase  should  never  ofiFend 
again.  We  were  also  accompanied  by  the  dust  con- 
tractor with  his  cart  and  men,  and  whilst  some  of  us  were 
engaged  reasoning  with  the  attentive  and  good-tempered 
crowd,  and  explaining  to  them  the  meaning  of  our  visit, 
others  examined  minutely  every  water  container ; 
another  group  collected  all  the  rubbish,  tins,  broken 
pots,  etc.,  and  took  them  out  to  the  cart.  There  is  little 
doubt  that  by  this  method,  and  it  is  the  plan  I  adopt 
wherever  I  go,  I  learn  more ;  at  the  same  time,  the 
people  also  learn  and  appreciate  the  attention  bestowed 
upon  them.  My  experience  of  the  state  of  cleanliness 
is  a  favourable  one.  Altogether,  I  examined,  from 
8th  March  to  25th  March,  in  Bridgetown,  525  yards. 
In  these  I  found  993  water-holding  receptacles, 
including : — 


Barrels 

177 

Tubs 

224 

Jars 

168 

Kerosene  tins 

44 

Buckets     . 

278 

Odds  and  ends 

100 

Cans 

2 

The  larvse  of  Stegomyia  calopus  were  found  upon  sixty 
premises ;  the  larvae  were  present,  therefore,  to  the 
extent  of  \\\  per  cent.  ;  this  is  a  comparatively  small 
proportion,  and  there  can  be  no  doubt  whatever  that 
this  proportion  must  be  infinitely  less  than  formerly. 


o    g 
^     'A 


2    S 

-  I 
2    ■^ 


CAUSE  OF  DIMINUTION  OF  LARVtE  125 

I  found  the  largest  number  of  breeding  places  in 
those  parts  of  the  town  where  the  cases  of  yellow  fever 
had  been  most  numerous. 

There  is  no  doubt  in  my  mind  that  the  factor  which 
has  led  to  the  diminution  of  the  breeding  places  of  the 
yellow   fever  mosquito  has  been  the  introduction  of  a 
pipe-borne    water-supply.     This    did    away    with    the 
necessity  of  storing  water  in  barrels,  for  the  water  is 
now  either  supplied  to  a  tap  on  the  premises,  or  to  a 
standpipe  in  the  road  near  by.     The   contrast  in   this 
respect  to  Belize,  where  I  found,  in  1905,  the  rain-water 
stored  in  innumerable  barrels,  was  very  striking.     The 
receptacles   which   were   found    most  frequently  with 
larvse,  were  the  wooden  water-barrels ;  and  the  ultimate 
destruction   of  the   breeding  places  of  the   Stegomyia 
resolves  itself  into  getting  rid  of  barrels,  for  now  that 
there  are  taps,  there  is  really  no  necessity  to  store  water. 
Of  course,  it  is  difi&cult  to  eliminate  old  customs  suddenly, 
and  many  cling  to  their  water-barrels.     I  found  that 
more  often  than  not,  the  drinking-water  barrels  were 
kept  in  the  kitchen — the  ideal  place,  owing  to  stillness, 
warmth,    and    subdued    light,    for    larvse    to    develop 
rapidly,   and,    moreover,    for  the   adult   Stegomyias  to 
find   close  at  hand  their   victims.     The  reasons  given 
for  keeping  the  drinking-water  in  the  kitchen,  was  that 
it  prevented  the  poisoning  of  the  water  by  revengeful 
neighbours,  which   might  happen  were   the   cask   left 
out  of  doors.     In  this  connection,  I  also  learnt  another 
curious   custom.      Time   and   time   again   I   found   no 
larvae  in  the  water  in  the  barrels,  when  circumstances 
indicated  that  they  should  be  present.     Their  absence 


126  HEALTH  PROGRESS  IN  BARBADOS 

was  due  to  the  presence  of  one  or  more  small  fish, 
placed  in  the  barrel,  to  detect,  so  I  was  informed,  the 
presence  of  poison,  should  it  be  added  by  anyone. 
The  poison  would  kill  the  fish,  which  would  float  to  the 
surface,  whereupon  the  water  would  be  thrown  away. 
No  doubt  this  custom  had  led  to  a  reduction  in  the 
amount  of  larvae.  Recently,  however,  the  factor  which 
has  above  all  others  brought  down  the  number  of 
breeding  places  on  premises  in  Bridgetown  and  in  other 
districts,  has  been  the  vigorous  inspection  of  all  yards. 
Great  credit  is  due  to  the  able  body  of  sanitary 
inspectors,  backed  up  by  the  infliction  of  judicious  fines. 
Since  my  departure,  I  have  been  informed  (18th  July 
1909)  that  a  recent  examination  of  premises  in  various 
parishes  has  shown  that  only  0*45  per  cent,  of  the 
houses  inspected  were  found  to  be  harbouring  larvse ; 
this  is,  as  my  informant  adds,  a  very  remarkable  result, 
which  does  credit  to  the  vigilance  of  the  inspectors.  It 
shows  what  can  be  done.  The  percentage  which  I 
found  in  March  was  approximately  \\\  per  cent. 
Surely  a  colony  which  can  bring  about  this  reform  is 
quite  capable  of  making  its  island  a  veritable 
sanatorium  and  a  model  to  others ! 

Injiiction  of  Fines. — The  inhabitants  having  been 
taught  by  the  inspectors  the  danger  of  harbouring 
larvae  and  cautioned  that  it  was  an  offence  to  do  so,  the 
next  step  was  the  bringing  obstinate  offenders  before  the 
magistrates  and  inflicting  fines.  This  has  been  done, 
and  altogether  some  99  convictions  were  obtained  from 
March  to  15th  May  1909  (see  Appendix).  This  also  is  a 
very  healthy  sign,  and  argues  well  for  the  future  secm^ity 


SANITARY  ADMINISTRATION  127 

of  Barbados — that  is,  if  this  enthusiasm  will  last  in  the 
absence  of  modern  organised  health  machinery. 

Health  and  Medical  Administration. — The  sanitary- 
organisation  of  Barbados  is  in  very  many  ways  antique  : 
as  ancient  and  as  picturesque  as  the  characteristic  sugar- 
cane-crushing windmills  dotted  all  over  the  island — 
eminently  respectable,  but  shabby  and  not  in  conformity 
with  the  present  age  nor  calculated  to  yield  the 
maximum  return. 

In  the  absence  of  any  precise  printed  information, 
Mr  Graham  Yearwood  had  kindly  furnished  me  with  the 
following  useful  digest  of  the  mediaeval  sanitary 
administrative  system  in  operation  in  the  colony,  dating 
from  1645. 

Parishes  and  their  Government. 

Control:  Central  or  otherwise. — The  island  of 
Barbados  was  divided  into  eleven  parishes  or  districts  in 
the  year  1645,  by  Mr  Philip  Bell,  the  Lieutenant-Governor 
of  this  island  at  that  period,  and  from  then  till  the 
present  time  has  remained  so  divided,  St  Michael's 
being  the  Metropolitan  parish.  Each  of  these  parishes 
is  governed  by  a  Vestry  or  Parish  Council  elected  by 
the  ratepayers  of  the  same,  and  is  quite  independent 
of  any  central  or  Government  control,  the  number  of 
vestrymen  being  not  less  than  ten  or  more  than 
sixteen  in  some  parishes,  and  not  less  than  six  or  more 
than  ten  for  others. 

Commissioners  or  Boards  appointed  by  Vestries. — 
The  Vestries  then  annually  from  their  body  appoint 
Commissioners  of  Highways,  who  have  charge  of  and 
control  of  those  Highways ;  Sanitary  Commissioners, 
who  are  vested  with  the  duty  of  maintaining  and  looking 
after  the  sanitation   of  the  parishes,  etc. ;   Poor  Law 


128  HEALTH  PROGRESS  IN  BARBADOS 

Guardians,  who  have  charge  of  and  maintain  the  poor 
of  the  parishes.  All  these  bodies,  once  appointed,  are 
emancipated  from  any  control  of  the  Vestry  dm*ing  the 
year  of  office,  and  can  only  be  called  to  account  by  the 
ratepayers  on  their  offering  themselves  for  re-election. 

Powers  and  Duties  of  Boards. — These  boards  appoint 
their  own  officials,  such  as  Inspectors  of  Highways, 
Sanitary  Inspectors,  Medical  Officers,  independently 
of  the  Vestries.  The  sanitary  boards,  about  which 
this  paper  is  principally  concerned,  consist  in  all 
parishes  other  than  St  Michael's  of  three  members, 
and  in  the  case  of  St  Michael's  of  nine  members,  five 
of  whom  must  be  vestrymen,  while  the  other  four  are 
nominated  and  appointed  by  the  Vestry  and  are  not 
bound  to  be  possessors  of  any  legal  qualification  for 
that  office. 

Sanitary  Commissioners  to  make  Returns:  Vestries 
hound  to  Furnish  Means. — These  sanitary  boards  are 
required  by  the  law  to  make  a  return  to  the  Vestries  of 
the  sums  of  money  which  shall  appear  to  them  to  be 
required  for  ordinary  sanitary  purposes  for  the  ensuing 
year,  and  in  cases  of  sudden  emergency,  such  as  the 
unexpected  appearance  of  dangerous  epidemics  requiring 
further  sums,  they  have  power  to  make  a  special  return 
thereof  to  the  Vestries,  which  body  is  required  to  raise 
and  place  in  the  hands  of  their  parochial  treasurer  all 
such  sums  as  may  be  called  for  by  the  commissioners, 
such  sums  to  be  raised  and  collected  from  the  rate- 
payers. 

Duties  of  Commissioners. — The  duties  of  the 
commissioners  are  defined  in  the  Public  Health  Act, 
1898-9,  and  may  be  summarised  as  follows  : — 

1.  To  appoint  inspectors,  of  which  there  are  two  in 
St  Michael's,  the  parish  being  divided  into  two 
districts,  with  six  sub-inspectors  in  each  district. 


SANITARY  SYSTEM  129 

but   at    present    there   are    eighteen    in   each 
district ; 

2.  To  make  bye-laws  ; 

3.  To  ensure  cleanliness ; 

4.  To  remove  nuisances  ; 

5.  To  inspect  houses  ;  and 

6.  Generally   to   maintain    sanitation,   etc.,   to    the 

highest  point  of  excellence. 

Open  Drainage  System  adopted. — Armed  with  these 
powers,  the  commissioners  have  from  time  to  time 
built  up  a  system  of  open  concrete  drains,  to  which  are 
connected  open  gutters,  short  tunnels,  short  pipes,  and 
partly  covered  drains.  In  such  cases  where  the  drains 
are  under  the  streets,  they  are  ventilated  at  intervals  by 
iron  grates  so  constructed  that  they  are  easily  opened 
for  removing  any  obstruction,  and  through  which  a 
hose  attached  to  the  fire  hydrants  can  be  placed  and  the 
drains  effectively  flushed  by  water  under  a  strong 
pressure,  thus  driving  everything  before  it  into  the 
outflow  into  the  sea  or  tidal  river. 

Labourers  appointed  to  Flush  and  Clean  Drains, — A 
stafi"  of  labourers  is  employed  with  suitable  implements 
for  sweeping  and  cleaning  daily  all  the  city  drains, 
which  are  used  only  for  the  purpose  of  receiving  the 
washing  of  the  streets,  water  from  houses,  and  storm- 
waters. 

Sewers. — There  are  no  covered  sewers  in  Bridge- 
town such  as  are  to  be  found  in  cities  in  other  places, 
the  system  being  one  of  open  drains. 

Nature  of  Sewage. — No  night-soil  or  other  faecal 
matter  is  permitted  to  be  thrown  into  the  drains, 
gutters,  etc.,  and  the  law  has  provided  ample  means  for 
punishing  all  offenders  when  caught — no  easy  matter, 
however. 

System    adopted  for    removing    Night-soil. — There 

I 


130  HEALTH  PROGRESS  IN  BARBADOS 

are   two   systems  in   use  for  the  reception   of  night- 
soil  :  — 

1.  The  old  pit. 

2.  The  bucket,  or  supposed  dry- earth  system. 

In  the  first  case,  these  pits  are  cleaned  out  when 
necessary,  and  their  contents  either  thrown  into  the 
sea,  or  taken  out  of  the  town  and  suburbs  and  buried 
in  the  earth  for  manurial  purposes. 

In  the  second  case,  they  are  emptied  nightly  into 
the  sea  from  places  provided  by  the  commissioners  at 
places  convenient  on  the  sea-shore;  a  ladder  or  steps 
is  pro^aded  down  to  the  sea,  so  that  after  being  emptied 
the  vessels  can  be  washed  out  with  sea- water. 

Disposal  of  Sewage  from  Water-closets. — The  dis- 
posal of  sewage  from  water-closets  is  provided  for  by 
the  following  regulations  : — 

1.  All   existing  water-closets,  and  all  water-closets 

hereafter  to  be  erected  in  the  city  or  suburbs 
of  Bridgetown,  shall  be  provided  with  separate 
pits  closed  with  masonry  and  unconnected  with 
any  other  pit  whatever. 

2.  No  urine  or  other  fluid  from  anywhere  except 

the  flush  from  the  water-closet  shall  be  allowed 
to  enter  any  water-closet  pit,  which  pit  shall  be 
provided  with  an  iron  ventilating  pipe  of  not 
less  than  1  inch  in  diameter,  reaching  not  less 
than  3  feet  above  the  eaves  of  surrounding 
buildings. 

Disposal  of  RuhUsh. — The  Bye-law  No.  2  provides 
that  the  occupiers  of  all  houses,  etc.,  shall  daily  have 
swept  the  yards  and  enclosures  thereof,  the  streets, 
pavements,  and  gutters  in  front  of  and  around  the 
same,  as  far  as  the  centre  of  the  streets,  some  time 
before  the  hour  of  8  a.m.        ^ 

Cleaning  of  Yards  and  Streets. — This  matter  is  then 


BKtOGETOV/N. 
BARBADois. 


FIG.   13. — PLAN   OF   BRIDGETOWN,   SHOWING  DISTRIBUTION   OF   WATER   TARS. 


[Face  page  130. 


SANITARY  SYSTEM  131 

removed  by  the  scavengers'  carts  supplied  by  the 
commissioners,  vrhich  go  round  the  town  and  remove 
the  same  to  such  place  or  places  as  the  commissioners 
require  it  to  be  placed.  At  the  present  time  the  place 
known  as  the  Eeef  is  being  rapidly  filled  up  and  re- 
claimed from  the  sea  by  this  refuse,  and  the  place 
known  as  the  Constitution  E-iver  and  Bay  Street 
improvement  grounds  are  being  similarly  dealt  with,  no 
dead  animal,  or  faecal  matter,  however,  being  allowed 
to  be  thrown  on  to  these  places. 

Droppings  of  Animals. — The  droppings  of  animals 
on  to  the  streets  are  eagerly  removed  by  small  boys  and 
old  men,  who  dispose  of  them  for  manming  gardens  and 
nursery  grounds. 

These  are  the  present  simple  methods  which  have 
been  adopted  by  the  sanitary  commissioners,  and  have  so 
far  been  found  to  be  most  satisfactory.  They  may  not  be 
the  most  up-to-date  ideas,  but  in  a  tropical  climate  they 
have  worked  well. 

With  regard  to  the  open  drainage  system  in  vogue 
in  Bridgetown  :  it  works  well,  and  by  constant  flushing 
the  drains  are  kept  clean ;  but  a  few  bad  ones  exist, 
some  running  underneath  houses. 

With  regard  to  the  cess-pit  system,  it  is  believed  that 
owing  to  the  exceedingly  porous  nature  of  the  coral 
limestone,  the  night-soil  soon  disappears ;  this  may  be, 
but  it  seems  to  me  that  it  is  unwise  in  any  case  to 
pollute  the  subsoil  water,  especially  as  the  island  obtains 
now  a  splendid  supply  of  drinking-water  derived  from 
the  subsoil.  The  coral  limestone,  like  all  these  forma- 
tions, is  full  of  large  fissures,  and  every  possible  care 
should  be  taken  to  keep  this  essential  and  magnificent 
water-supply  absolutely  above  suspicion.  This  can  only 
be  done  by  doing  away  with  the  sunken  pits. 


132  HEALTH  PROGRESS  IN  BARBADOS 

In  view  of  the  threatened  spread  of  plague  towards 
the  West  Indies,  it  would  be  advisable  to  have  more 
space  underneath  the  houses.  At  present  very  many 
of  them  are  too  close  to  the  ground,  and  the  tendency 
is  to  throw  odds  and  ends,  rags,  and  rubbish  generally, 
underneath.  Owing  to  the  smallness  of  the  space,  the 
rubbish  cannot  be  easily  got  out.  I  had  an  opportunity 
of  seeing  one  of  these  houses  taken  down  and  the 
accumulation  of  several  years'  rubbish  revealed.  This 
rubbish  is  the  ideal  nesting  place  of  plague,  rats  and  fleas, 
and  constitutes,  to  my  mind,  the  greatest  danger  at  the 
present  time  in  Bridgetown.  It  is  a  very  real  danger, 
and  should  be  rectified  without  delay.  The  houses 
should  be  raised  so  as  to  let  the  sun  and  air  and  the 
eyes  of  the  sanitary  inspector  have  full  play  :  these  are 
the  deadly  enemies  of  rats  and  fleas.  The  broad 
comment  upon  the  existing  sanitary  system  is  that  as 
far  as  it  goes  it  is  excellent,  and  has  done  good  work  in 
the  past  and  in  times  of  peace — that  is,  when  no  sudden 
emergency  has  cropped  up.  In  this  respect,  it  is  again 
like  other  "good  old"  systems  all  the  world  over. 

A  medical  gentleman  of  very  considerable  experience 
in  Barbados  has  very  kindly  furnished  me  with  a  digest  of 
the  weakness  of  the  sanitary  and  medical  administra- 
tion, and  as  I  personally  endorse  the  views  expressed 
therein,  I  reproduce  them  here  : — 

The  general  board  of  health  have  plenary  powers 
to  pass  orders,  rules,  and  regulations  to  meet  any 
emergency,  such  as  the  approach  of  a  serious  epidemic, 
or  to  stimulate  the  activity  of  the  boards  of  sanitary 
commissioners  during  periods  when  special  preventive 


ABSENCE  OF  HEALTH  REPORTS  133 

measures  are  necessary.  The  board  also  pass  bye-laws 

and   special  regulations  submitted    to    them    by    the 

respective     boards     of  sanitary      commissioners,     if 
approved. 

There  are,  however,  no  regular  health  reports 
submitted  to  the  board  of  health,  and  no  information 
as  to  the  health  conditions  of  the  island  is  forthcoming 
unless  specially  asked  for.  Consequently  the  board  of 
health  are  not  aware  whether  at  any  given  period  the 
sanitary  conditions  are  such  as  may  be  reasonably 
expected  to  stand  the  strain  of  the  sudden  introduction 
of  infectious  diseases.  From  this  it  follows  that  neither 
the  Executive,  the  board  of  health,  nor  the  general 
public  can  feel  that  the  sanitary  organisation  is  such  as 
to  make  it  impossible  for  these  diseases  to  gain  a 
footing.  There  is,  in  consequence,  general  uneasiness, 
amounting  often  to  actual  panic,  on  the  near  approach  of 
any  dangerous  epidemic,  and  in  the  presence  of  an 
outbreak  of  yellow  fever  or  smallpox  an  extempore 
organisation  is  hastily  made  to  enable  the  sanitary 
authorities  to  meet  the  emergency. 

Neither  the  Executive  nor  the  board  of  health  have 
a  medical  officer  to  keep  them  informed  of  the  health 
conditions  of  the  island,  to  give  a  responsible  opinion 
about  the  nature  of  an  infectious  disease  which  may  make 
its  appearance,  to  suggest  preventive  measures  for 
controlling  these  special  diseases  or  the  ordinary 
diseases  which  prevail  under  insanitary  conditions  in 
any  community.  For  example,  if  any  local  outbreak  of 
typhoid  fever  occurs,  no  special  attention  is  directed  to 
its  causes  unless  it  assumes  alarming  proportions,  and 
there  is  no  regular  inspection  of  the  sanitary  work  of 
the  island  to  ascertain  any  defects  which  exist,  or  to  make 
responsible  suggestions  for  its  improvement. 

Again,  the  boards  of  sanitary  commissioners  in  the 
respective  parishes  have  no  sanitary  medical  officer  to 
advise  them  in  health  matters  or  to  carry  out  effectively 


134  HEALTH  PROGRESS  IN  BARBADOS 

the  measures  necessary  to  control  a  serious  outbreak  of 
epidemic  disease. 

In  most  parishes  the  parochial  medical  officer, 
appointed  under  the  Poor  Kelief  Act  to  attend  the  poor 
of  the  parish,  has  a  seat  at  the  sanitary  board  and  is 
the  adviser  of  the  board  on  health  matters,  but  his  only 
responsible  duty  is  to  make  a  quarterly  report  on  the 
sanitary  condition  of  his  parish.  There  is  no  definite 
inspection  or  enquiry  into  health  matters  required  of 
him,  and  the  reports  are  often  perfunctory. 

As  the  appointment  of  the  parochial  medical  officer  is 
in  the  hands  of  the  local  Vestry,  which  can  at  any  time 
relieve  him  of  his  appointment  at  six  months'  notice,  he  is 
not  in  a  position  to  comment  fearlessly  on  insanitary 
conditions,  which  may  offe^idthe  susceptibilities  of  vestry- 
men, on  whose  goodwill  his  tenure  of  office  depends ;  and, 
human  nature  being  what  it  is,  he  is  apt,  unless  he  is  a 
man  of  more  than  ordinary  courage  and  fearlessness,  to 
see  things  as  his  employers  see  them. 

In  order  to  raise  the  standard  of  sanitary  organisa- 
tion in  the  island  and  to  make  it  what  the  conditions  of 
the  West  Indies  Sanitary  Convention  imply  that  it 
should  be,  the  following  improvements  are  necessary  : — 

1.  A  permanent  infectious  hospital  in  each  parish 
for  the  treatment  of  the  four  quarantinable  diseases, 
smallpox,  yellow  fever,  plague,  and  cholera,  which  may 
be  used  in  the  absence  of  these  diseases  for  the  treat- 
ment of  typhoid  fever  and  other  ordinary  infectious 
diseases. 

2.  The  appointment  of  the  parochial  medical  officer 
in  each  parish  as  medical  officer  of  health  for  the 
district.  He  would  be  the  responsible  adviser  of  the 
sanitary  board,  and  his  duties  would  consist  in  sanitary 
inspection  duty  and  the  furnishing  of  reports  on  the 
sanitary  condition  of  the  district,  according  to  a  fixed 


NECESSITY  FOR  APPOINTING  MEDICAL  OFFICER   13o 

scheme,  as  obtains  in  England.  He  would  also 
examine  persons  under  surveillance  according  to  the 
provisions  of  the  Quarantine  Act,  when  the  health 
officer  cannot  inspect  them  owing  to  the  distance  of 
their  homes  from  Bridgetown,  or,  in  the  case  of  persons 
residing  in  Bridgetown  or  St  Michael's,  when  the 
numbers  under  smweillance  are  greater  than  the  health 
officer  of  the  port  can  deal  with.  He  would  also  per- 
form extra  duties  in  the  case  of  an  epidemic,  such  as 
the  examination  of  all  persons  reported  by  the  sanitary 
inspectors  as  ill  at  their  homes,  the  treatment  of  persons 
in  the  infectious  hospital,  the  examination  of  contacts, 
and  the  regular  inspection  of  the  infected  areas,  to 
discover  any  conditions  which  promote  the  spread  of 
the  epidemic.  The  duties  described  in  the  last  two 
sentences  are  now  paid  for  by  extra  fees,  often 
amounting  to  considerable  sums. 

These  officers  should  be  appointed  by  the  Vestries, 
subject  to  the  approval  of  the  Governor  in  executive 
committee,  and  half,  at  least,  of  their  salaries  should  be 
paid  from  the  general  revenue. 

3.  The  appointment  of  an  island  medical  officer  of 
health,  who  would  be  the  responsible  adviser  of  the 
Government  and  the  board  of  health  in  sanitary 
matters,  who  would  make  regular  sanitary  inspections 
throughout  the  island,  and  furnish  reports  of  the  health 
and  sanitary  conditions  existing,  who  would  be  avail- 
able for  advice  and  assistance  to  the  boards  of  sanitary 
commissioners  and  the  parochial  medical  officers  of 
health,  and  be  responsible  for  consultation  on  any 
doubtful  diseases  that  arise.  His  duties  would,  in 
short,  be  like  those  of  a  county  medical  officer  of 
health  in  England. 

He  should  be  appointed  and  paid  by  the  Government 
fi'om  general  revenue,  and  would  be  at  the  disposal  of 
Government  and  the  board  of  health,  as  the  health 
officer  of  the  port  is. 


136  HEALTH  PROGRESS  IN  BARBADOS 

Sickness  and  Mortality  Returns. — The  weakness  of 
the  present  situation  is  glaringly  revealed  when  it  is 
understood  that  there  is  no  registration  of  the  causes 
of  death.  In  practice,  the  death  of  every  person  who 
dies  without  having  been  seen  by  a  registered  medical 
practitioner,  is  notified  by  the  police  to  the  coroner,  and, 
except  in  cases  where  the  cause  of  death  is  patent,  an 
inquest  into  the  cause  of  death  is  made.  From  this  it 
is  easy  to  understand  how  very  readily  an  epidemic  may 
get  a  start  before  being  discovered.  I  have  pointed  out 
before  that  it  would  be  a  commercial  advantage  to  the 
colony  to  have  a  proper  registration  as  to  the  cause  of 
death.  The  island  is  not  unhealthy,  and  ofl&cial  regular 
reports  of  mortality  and  sickness  rates  is  the  only 
method  whereby  the  outside  world  can  be  made  aware 
of  the  health  of  the  colony.  Barbados  has  nothing  to 
hide  and  nothing  to  lose  by  the  publication  of  these 
reports ;  on  the  contrary,  everything  to  gain.  Besides, 
it  is  the  practice  of  civilised  nations ;  for  by  its  means 
any  undue  mortality  is  at  once  revealed  and  the  sanitary 
machinery  set  in  motion. 

The  present  state  of  affairs  is  barbaric  and  primitive, 
and  the  sooner  it  is  rectified  the  better  will  it  be  for 
the  reputation  of  the  island,  which  must  suffer  as  long 
as  it  exists ;  for  it  must  be  taken  as  a  sample  of  the 
childishness  and  stupidity  of  the  people,  and  there- 
fore must  react  prejudicially  upon  business.  If  large 
commercial  centres  are  examined  in  Europe  and  in  the 
United  States,  it  will  be  found  that  in  these  places  the 
sanitary  organisation  is  brought  to  the  highest  degree  of 
perfection,  so  that  the  representatives  of  all  nations  and 


ISOLATION  HOSPITALS  137 

of  every  side  of  commerce  and  industry  may  see  what 
is  done  to  protect  health.  I  therefore  sincerely  trust 
that  the  Government  will  not  lose  time  in  bringing  in 
a  bill  for  the  registration  of  deaths  and  the  causes  of 
mortality,  and  for  the  establishment  of  an  island 
medical  ofl&cer  of  health  and  the  appointment  of 
medical  officers  of  health  in  each  parish,  to  act  as 
medical  officers  of  health  for  each  district.  These  are 
not  difficult  nor  costly  reforms,  and  they  would  lift 
Barbados  into  the  first  rank. 

In  addition  to  the  antilarval  measures  which  had 
been  started  when  I  arrived  in  the  colony,  I  also  found 
that  measures  had  been  taken  to  fumigate  houses  in 
which  yellow  fever  had  occurred,  and  also  that  provision 
had  been  made  for  the  isolation  of  cases  of  yellow 
fever. 

Isolation  Hospitals. — A  circular  was  issued  on 
7th  May  1907,  to  commissioners  and  inspectors  of 
health  of  all  parishes  by  the  general  board  of  health, 
drawing  their  attention  to  the  importance  of  providing 
suitable  isolation  for  all  cases  of  yellow  fever.  During 
my  visit,  I  made  it  my  business  to  visit  all  the  parishes 
in  the  island  and  ascertain  what  provision  had  been 
made.  I  found  that  with  commendable  promptness 
provision  of  some  sort  or  another  had  been  made.  In 
some  instances  a  wing  or  a  room  in  the  almshouse  had 
been  efiectively  screened,  or  in  other  cases  a  small 
house  had  been  rented  and  thoroughly  screened  with 
mosquito  netting.  All  this  had  been  carried  out  with 
very  small  expense  (see  Appendix),  and  the  result  was 
excellent.     I  found  that  the  patients  preferred  to  enter 


138  HEALTH  PROGRESS  IN  BARBADOS 

these  emergency  hospitals  rather  than  remain  at  home. 
For  the  prompt  manner  in  which  these  emergency 
hospitals  were  got  under  way,  great  credit  is  due  to  the 
parochial  medical  oJBficers,  and  the  example  of  their 
worth  constitutes  a  very  strong  reason  in  my  mind 
for  advising  the  Government  to  promote  them  into 
district  medical  officers  of  health,  and  so  to  make  them 
into  medical  officers  for  their  parishes.  They  are  fully 
quahfied  for  this  office,  and  the  Government  is  fortunate 
in  having  such  a  body  of  men  ready  at  hand.  It  now 
remains  to  make  official  use  of  them,  for,  as  things  are, 
they  have  no  official  executive  power. 

Fumigation. — Fumigation  of  houses  in  which  yellow 
fever  occurred  was  carried  out,  but  there  is  every  reason 
to  believe  that  in  very  many  instances  the  fumigation  was 
not  effective.  The  inspectors  have  most  kindly  furnished 
me  with  notes  from  their  diaries,  and  from  these  it  is 
evident  that  fumigation  was  far  from  complete.  The 
chief  fault  was  that  the  house  was  not  made  mosquito- 
tight  before  the  fumigation  started,  and  in  consequence, 
no  doubt,  a  very  considerable  number  of  infected 
mosquitos  escaped  into  adjoining  houses;  this  is 
assuredly  the  reason  why  the  fever  continued  to  spread. 

I  am  aware  there  are  difficulties  in  sealing  efficiently 
a  thrash  hut  or  even  a  shingle-covered  house.  But  it  is 
by  no  means  insurmountable.  The  extraordinary 
success  of  the  anti-yellow  fever  work  in  Cuba,  where 
the  fever  time  and  time  again  has  been  stamped  out 
almost  as  soon  as  it  was  discovered,  has  been  due  to  the 
complete  fumigation  of  these  huts  in  the  poorer  country 
districts.     Now,  what  can  be  done  in  Cuba  under  even 


QUARANTINE  ADMINISTRATION  139 

more  trying  circumstances  than  in  Barbados,  can  be 
equally  well  performed  in  Barbados.  What  is  required 
is  a  conscientious  and  ingenious  sanitary  officer,  either 
himself  to  carry  out  the  work  or  see  that  it  is  properly 
done.  It  must  always  be  borne  in  mind,  that  if  a  small 
aperture  is  left  unclosed,  the  infected  Stegomyias  will 
escape  through  that  aperture,  and  an  escaped  infected 
Stegomyia,  in  its  power  for  doing  harm,  can  best  be 
compared  to  a  mad  dog  roving  through  the  town ; 
indeed,  in  its  effects  in  holding  up  trade,  the  Stegomyia 
produces  more  disastrous  results  than  does  the  rabid 
dog. 

Quaraiitine  Administration. — Useful  and  intelligent 
as  have  been  the  inter- colonial  West  Indian  quarantine 
measures,  the  impression  which  I  have  formed  of  them 
is,  that  they  are  largely  founded  on  mutual  mistrust  and 
suspicion.  In  Barbados,  yellow  fever  found  its  way  into 
the  island,  and  slowly  spread  and  lingered  on.  From 
whence  it  may  have  come,  whether  from  Trinidad, 
Martinique,  or  the  Amazon,  it  is  difl&cult  now  to  say. 
For  unless  a  searching  enquiry  is  started  at  once,  the 
chance  of  getting  on  the  right  track  is  lost,  and  room  is 
only  left  for  speculation,  which  in  nine  cases  out  of  ten 
is  misleading  and  erroneous. 

Once  Barbados  was  infected,  it  became  a  source 
of  intense  anxiety  to  neighbouring  colonies,  as  an 
analysis  of  the  numerous  official  complaints  of  other 
West  Indian  colonies  is  ample  proof.  I  will,  however, 
in  this  place,  again  point  out  that  if  the  want  of  a 
medical  head  is  glaringly  apparent  in  the  internal 
sanitary  administration  of  the  colony  of  Barbados,  the 


140  HEALTH  PROGRESS  IN  BARBADOS 

want  of  such  a  head  when  dealing  with  questions  of 
external  sanitary  administration  and  policy  is  still  more 
prominently  emphasised.  In  this  relationship,  the  want 
of  an  experienced  medical  adviser,  who  shall  be  in 
immediate  touch  with  the  health  conditions  and  health 
machinery  of  the  whole  colony,  and  likewise  with  the 
conditions  obtaining  in  the  sister  colonies,  becomes 
painfully  manifest  at  every  point.  Barbados  possesses 
a  quarantine  medical  officer — a  gentleman  well  qualified 
to  inspect  the  ships.  Such  an  ofiicer  is  undoubtedly  of 
great  service  for  carrying  out  that  special  section  of 
sanitary  administration  which  deals  with  the  careful 
supervision  of  all  ships  entering  the  port.  But  at  the 
head  of  the  sanitary  organisation  there  should  be  a  man 
who,  by  his  training  and  local  knowledge,  is  in  touch 
with  every  square  foot  of  the  colony,  and  who,  further- 
more, is  in  intimate  relationship  with  his  professional 
brethren  throughout  the  island.  Large  ports  in  England 
and  Scotland  have,  as  a  matter  of  course,  a  chief  medical 
officer  of  health,  who  keeps  himself  daily  informed  of  all 
sickness  in  his  city  and  district  and  port.  He  knows 
exactly  what  cases  there  are  of  smallpox,  scarlet  fever, 
etc.  His  quarantine  officers  board  every  ship  which 
arrives,  and  report  to  him.  The  medical  officer  of 
health  is  the  supreme  authority,  who  will  decide  upon 
what  action  will  be  taken,  and  not  the  quarantine 
officer.  The  medical  officer  of  health  is  naturally  in  a 
better  position  to  do  so  than  the  quarantine  officer, 
whose  whole  time  should  be  devoted  to  examining 
arrivals.  At  the  present  time  the  quarantine  officer 
in   Barbados   reports   to   a   quarantine    board,   largely 


EARLY  DIAGNOSIS  141 

composed  of  laymen ;  but  as  it  does  not  possess  a  chief 
medical  officer,  I  maintain  that  with  the  best  intentions 
possible,  it  cannot  be  in  a  position  to  give  the  best 
decision.  A  decision  in  matters  of  quarantine  requires 
the  opinion  of  an  experienced  medical  officer  of  the 
standard  of  those  to  be  found  in  European  and  American 
trading  ports.  Laymen  cannot  give,  or  be  expected  to 
give,  such  an  opinion  any  more  than  the  medical  officer 
would  presume  to  advise  on  matters  of  trade  or 
shipping.  Therefore  from  this  aspect  alone  the  position 
of  Barbados  is  an  exceedingly  weak  one,  and  untenable. 
I  will  give  some  illustrations  which  arose  in  1907  : — 

Difficulty  of  EmHy  Diagnosis.' — The  quarantine  officer 
reported,  August  1907,  to  the  quarantine  board  a  case 
about  which  he  was  not  absolutely  certain  was  yellow 
fever  or  not,  and  which  consequently  was  not  reported 
as  such.  Shortly  afterwards  the  case  developed  typical 
black  vomit  and  died,  and  there  could  be  no  longer 
doubt  that  it  was  a  case  of  yellow  fever.  Now,  it  is 
precisely  in  connection  with  a  case  like  this  that  the 
opinion  of  an  experienced  medical  officer  is  required. 
Similar  situations  of  doubt  have  over  and  over  again 
occurred  in  ports  like  Liverpool  and  elsewhere,  over 
cases,  say,  of  smallpox.  In  these  cases  of  doubt, 
invariably  the  opinion  of  the  medical  officer  of  health 
is  taken,  and  if  he  finds  necessary,  other  experienced 
men  are  called  in.  The  uncertainty  of  the  quarantine 
officer  in  this  particular  case  might  have  meant  disaster 
to  St  Lucia.  It  is  precisely  to  meet  cases  of  this  kind 
that  a  senior  official  is  absolutely  necessary,  on  the 
principle  that  two  heads  are  better  than  one  in  matters 


142  HEALTH  PROGRESS  IN  BARBADOS 

of  so  delicate  a  nature  as  diagnosis.  I  can  speak  from 
my  own  experience  in  the  city  of  Liverpool,  and  others 
will  agree,  upon  the  imperative  necessity  of  taking 
counsel  with  other  authorities  in  matters  which  are 
admittedly  difficult  for  one  man  to  decide.  The  late 
Administrator  of  St  Lucia,  Mr  P.  C.  Cork,  a  gentleman 
having  very  considerable  knowledge  of  all  that  was  most 
recent  in  yellow  fever  prophylaxis,  and  of  much  practical 
experience,  wrote  to  the  Government  of  Barbados,  point- 
ing out  the  importance  to  his  colony  of  immediate 
notification  of  cases  of  yellow  fever,  in  view  of  the  fact 
of  the  constant  and  easy  communication  between  the 
two  islands,  the  voyage  only  occupying  a  few  hours. 
The  Administrator  then  proceeded  to  point  out  that  in 
many  instances  several  days  had  elapsed  after  the 
patients  were  either  isolated  or  had  died  before  the  offi- 
cial notification  was  received.  The  explanations  of  this 
delay,  as  given  by  the  administration  of  Barbados,  was 
to  the  effect  that  unfortunately  the  doctors  in  attendance 
upon  the  cases  in  question  had  not  been  able  to  agree 
upon  the  diagnosis  until  after  some  days'  observation,  or 
the  man's  death ;  which  means  that  St  Lucia,  or  any 
other  adjacent  colony,  not  being  on  their  guard,  might 
have  easily  let  yellow  fever  in,  all  because  of  the 
indecision  of  certain  medical  practitioners.  But  it  is 
precisely  in  order  to  have  an  assessor  or  adjuster  that 
the  post  of  medical  officer  is  created.  It  so  happened 
that  in  Barbados  there  was  an  experienced  medical 
consultant  who  had  no  doubt  as  to  what  the  disease  in 
question  was,  but  owing  to  the  faulty  medical  organisa- 
tion he  could  not,  apparently,  be  officially  consulted. 


INTERCOLONIAL  MISTRUST  143 

Now,  all  this  breeds  mistrust,  the  inter-colonial  mistrust 
which  is  to-day  so  painfully  evident.  On  the  other 
hand,  the  essence  of  good  business  in  any  walk  of  life  is 
to  inspire  confidence.  Confidence  in  the  Law  has  been 
inspired  by  the  estabhshment  of  solicitors  and  attorney- 
generals  and  judges  of  all  kinds ;  and  so  in  medicine 
and  sanitation,  confidence  can  only  be  given  by  appoint- 
ing experienced  medical  experts.  This  is  the  practice 
of  civilised  communities,  and  it  is  but  common  sense. 

Diseases  in  Barbados. — If  the  stranger  and  well- 
wisher  of  Barbados  wishes  to  know  what  are  the  diseases 
of  Barbados,  and  to  see  how  healthy  it  is  before  he  takes 
his  business  there  or  settles  with  his  family,  he  is 
unable  to  get  any  annual  report  of  the  sickness  rate,  or 
in  fact  anything  recent  which  will  guide  him  in  forming 
an  opinion;  there  is  no  medical  head,  no  authority 
whose  duty  it  is  to  regularly  furnish  this  particular  and 
very  necessary  information.  If  the  student  requires 
similar  information,  he  has  to  get  it  as  best  he  can  from 
the  inedical  men  of  the  colony. 

There  appears  to  be  no  endemic  malaria.  Forms  of 
filariasis  are  present,  and  also  the  disease  known  as 
pellagra  or  psilosis  pigmentosa.  Reports  have  been 
written  upon  this  disease  by  Dr  T.  Sinclair  Browne 
and  by  Dr  Manning,  the  Superintendent  of  the 
Asylum. 

Climate  and  Natural  Advantages  of  Barbados. — In 
my  experience,  Barbados  is  second  to  no  other  part  of 
the  world  in  possessing  natural  advantages.  It  has  a 
beautiful  climate ;  the  island  resembles  a  large  pontoon 
anchored  in  the  South  Atlantic,  and  is  in  consequence 


144  HEALTH  PROGRESS  IN  BARBADOS 

continually  swept  by  the  most  refreshing  breezes.  The 
general  appearance  of  the  island  is  beautiful  beyond  com- 
parison, recalling  the  appearance  of  the  mother  country 
in  May  and  June.  There  is  no  dense  tropical  bush ; 
grass-land,  sugar-cane,  and  cotton  meet  the  eye  every- 
where. The  soil,  for  a  tropical  country,  from  the  point 
of  view  of  health,  is  an  ideal  one — coral  limestone  rock, 
pearly  white  and  as  absorbent  as  a  sponge,  so  that  no 
water  rests  upon  it ;  water  soaks  through  at  once.  The 
climate  is  therefore  dry,  and,  together  with  the  Atlantic 
breezes,  made  delightfully  refreshing.  I  had  the 
advantage  of  motoring  through  every  parish  in  the 
island  with  my  companion,  Dr  Hutson,  and  I  can 
certainly  say  that  the  beauty  of  the  white  coral  roads 
winding  through  the  lovely  green  meadows  and  cane- 
fields,  reheved  at  every  point  by  sugar  windmills  and 
clumps  of  cabbage  palms,  is  a  picture  never  to  be 
forgotten,  and  in  my  opinion,  Barbados  ought  to  become 
the  ideal  recuperating  ground  of  the  tired- out  and  sick 
ones  of  Europe  and  the  United  States.  I  shall  never 
forget  the  feeling  of  absolute  repose  coupled  with  the 
stimulating  and  invigorating  effect  of  the  climate  and 
scenery  which  I  experienced  at  all  hours  of  the  day, 
whether  in  the  early  morning,  in  the  noonday  sun, 
when  the  dazzling  roads  glared  out,  or  in  the  late 
eventide;  no  matter  what  the  hour,  everything  in  life 
appeared  sweet.  Yes,  Kingsley  said  it  was  "  At  Last," 
and  I  re-echoed  "At  Last,"  "At  Last."  And  as  if  to  show 
how  pleased  nature  was  with  its  handiwork,  it  refrained 
from  planting  malaria.  There  is  no  malaria  indigenous 
to  Barbados.     It  is  one  of  those  parts  of  the  tropical 


NO  ENDEMIC  MALARIA  145 

world  which  stands  out  unique  in  this  respect.  The 
old  medical  chroniclers  have  drawn  attention  to  this 
fact :  that  whereas  man  had  in  the  past  introduced 
yellow  fever  until  it  became  endemic,  malaria,  on  the 
contrary,  appears  never  to  have  been  endemic.  We 
now  know  that  the  malaria-carrying  mosquitos — the 
Anophelines — appear  to  be  absent  from  Barbados ;  most 
probably  this  is  due  to  the  fact  that  the  suitable 
conditions  for  their  development  do  not  exist.  Owing 
to  the  nature  of  the  soil,  the  storm-water  is  rapidly 
carried  off  through  the  innumerable  "sucks,"  which  are 
everywhere  to  be  found  in  the  porous  coral  rock,  and 
what  permanent  ponds  do  exist  seem  to  be  perpetually 
stocked  with  minute  fish — the  "  millions  "—which  effec- 
tively get  rid  of  any  mosquito  larvse.  Nor  is  there  any 
bush  on  the  branches  of  which  epiphytes  might  find  a 
foothold  and  water  accumulate,  and  so  afford  breeding 
places.  No,  the  only  homes  the  mosquito  can  find  are 
furnished  to  a  very  large  extent  by  man  in  the  shape  of 
barrels,  cisterns,  odds  and  ends,  and  drains.  Remove 
these  and  cleanse  the  drains,  and  the  mosquito  must 
perish  in  Barbados.  Therefore,  as  the  line  of  action  has 
been  so  clearly  outlined  by  Providence,  there  can  be 
little  doubt  that  Barbados  will  follow  up  and  render  the 
island  mosquito-free,  and  the  envy  and  admiration  of 
the  rest  of  the  tropical  world.  It  is,  indeed,  a  reputa- 
tion worth  winning,  and  will  cost  very  little.  By  the 
foreshore  the  innumerable  crabs  make  a  vast  quantity 
of  water-holding  holes,  which  in  turn  give  rise  to  a 
large  volume  of  mosquitos,  but  fortunately  neither 
Anophelines  nor  Stegomyia. 

K 


146  HEALTH  PROGRESS  IN  BARBADOS 

"  Barbados  leg "  and  other  forms  of  filariasis,  such 
as  "fever  and  ague,"  ''rose,"  etc.,  do  exist,  and  are  no 
doubt  dependent  upon  the  supply  of  culex,  which  is  still 
abundant ;  but  culex  will  be  swept  away,  and  with  it  the 
diseases. 

It  is  worthy  of  note  that  the  natives  of  Barbados 
are  exceedingly  liable  to  malaria  of  a  very  severe  type 
— that  is,  when  they  expose  themselves  to  infection  in 
other  countries.  In  this  respect,  they  are  as  susceptible 
as  any  newly  arrived  European.  This  is  in  favour  of 
the  contention  that  there  is  no  indigenous  malaria  in 
Barbados.  I  have  already  mentioned  that  during  the 
recent  outbreak  of  yellow  fever  the  natives  suffered 
even  more  than  the  whites,  showing  also  that  owing  to 
improved  water-supply  the  annual  recurrences  of  yellow 
fever  had  disappeared  from  the  island,  and  with  the 
periodic  cessation  of  the  fever  the  previous  natural 
immunity  of  the  natives  likewise  went. 

Another  disease  which  attracts  attention  is  pellagra 
or  psilosis,  and  about  which  we  know  very  little. 

Leprosy.- — I  visited  the  Lazaretto,  where  some  121 
cases  of  leprosy  are  looked  after.  I  also  visited  the 
General  Hospital,  where  there  are  very  many  interesting 
cases.  In  comparison  with  similar  institutions  in 
Trinidad  and  British  Guiana,  one  appreciates  at  once 
that  whereas  in  the  last-named  places  one  observes  at  all 
points  the  organising  hand  of  a  medical  head,  and  that 
some  scientific  use  is  made  of  the  immense  field  for 
investigation  which  these  institutions  offer;  by  this 
means  helping  along  the  study  of  tropical  diseases  to 
the  advancement  of  medicine  and  the   alleviation   of 


LACK  OF  ORGANISATION  147 

suffering.  In  Barbados,  on  the  other  hand,  it  is 
exceedingly  disappointing  to  meet  with  very  little 
scientific  interest,  and  no  building-up  of  a  pathological  or 
bacteriological  department.  In  these  respects  there  is 
a  marked  contrast  with  what  exists  in  Demerara  and 
Trinidad,  where  useful  researches  are  being  continually 
made,  and  where,  moreover,  exceedingly  good  work  has 
already  been  done  and  published.  I  am  convinced, 
moreover,  that  the  hospital  authorities  in  Barbados 
will  find  it  difficult  to  attract  enthusiastic  young  men 
unless  they  are  prepared  to  recast  their  system.  Nor 
do  I  think  that  they  are,  under  present  arrangements, 
in  a  position  to  reap  the  full  benefits  of  the  appointment 
of  a  pathologist  or  bacteriologist :  although,  of  course, 
it  is  most  desirable  that  such  an  appointment  should 
ultimately  be  made — but  not  until  a  chief  medical 
officer  of  health  is  created. 

Gomvnment  Entomologist. — In  Mr  Ballou,  of  the 
Imperial  Department  of  Agriculture,  the  colony 
possesses  an  excellent  entomologist,  and  it  is  to  be 
hoped  that  with  improved  organisation  the  services  of 
this  gentleman  will  be  utilised  by  the  medical  as  well 
as  the  agricultural  department,  as  in  the  case  of  the 
other  islands. 

On  30th  March  I  took  leave  of  Barbados,  after  having 
spent  four  weeks  in  the  island,  during  which  time  I  got 
to  know  and  to  love  its  inhabitants.  The  freshness 
and  sprightliness  of  the  island  has  had  its  effect  upon 
all  classes.  Everyone  wears  a  smile  on  his  face.  I 
found  exceedingly  little  surliness ;  the  motto  which  I 
adopted,  "Wear  a  smile  on  your  face  and  a  flower  in 


148  HEALTH  PROGRESS  IN  BARBADOS 

your  buttonhole,"  admirably  suited  the  temperament  of 
all,  although  the  island  was  passing  through  a  period 
of  great  depression.  The  sanitary  inspectors  with 
whom  I  had  worked  every  day  during  March  all  came 
down  in  a  body  to  the  steamer  to  see  me  off,  as  also 
did  my  two  companions,  Mr  Yearwood  and  Dr  Hutson, 
and  my  most  kind  host  and  hostess,  the  Governor  Sir 
Gilbert  Carter  and  his  wife. 

I  sailed  forth  bearing  with  me  nothing  but  the  most 
pleasant  recollections,  and  an  intense  wish  to  do  all  in 
my  power  to  render  the  health  conditions  of  their 
beautiful  island  second  to  none  in  any  quarter  of  the 
globe ;  and  I  firmly  believe  this  can  be  done,  and  it  is 
with  that  conviction  and  in  that  spirit  that  I  have 
ventured  to  make  the  suggestions  and  criticisms  which 
I  have  done  in  the  preceding  chapter. 


CHAPTEE  XI 

HEALTH   PROGRESS   AND    ADMINISTRATION   IN   GRENADA 

On  1st  April  I  arrived  in  Grenada  :  I  confess  it,  with 
considerable  emotion.  Sir  Frederick  Treves,  in  his 
Cradle  of  the  Deep,  has  pictured  to  us  the  stout  hearts 
which  our  ancestors  must  have  had  to  brave  the  life  on 
sea  in  the  days  of  the  sailing-ships ;  he  has  pictured  to 
us  the  awful  discomfort  of  the  sea  passage  of  the 
sailing-ship  of  those  days.  "Well,  here  I  was,  now 
landing  in  Grenada  after  a  most  enjoyable  voyage 
in  the  R.M.S.P.  Company's  ship  Tagus,  with  all  the 
modern  comforts  of  a  well-found  craft,  splendid 
cuisine  and  sleeping  accommodation,  and  only  thirteen 
days  from  Southampton  to  Barbados.  Yet  only  a  few 
decades  before,  my  mother,  then  a  schoolgirl,  had  set 
out  on  a  sailing-ship  to  join  her  sister  in  Grenada — a 
voyage  of  nine  weeks,  and  faced  what  food !  and  what 
accommodation !  She  used  to  describe  to  me  how, 
often,  the  few  passengers  on  board  had  to  hold  their 
noses  when  they  took  a  cup  of  tea — no  frozen  nor 
condensed  milk  was  ever  heard  of  then ;  and  to  make 
the  misery  still  worse,  the  usual  ships'  fever,  "Yellow 
Jack,"  broke  out,  and  one  by  one  the  crew  were  consigned 


150  HEALTH  PROGRESS  IN  GRENADA 

to  the  deep,  and  then  finally  they  had  to  face  the  ordeal 
of  the  quarantine  of  those  days. 

Grenada  is  a  beautiful  island,  rendered  all  the  more 
striking  by  contrast  with  Barbados.  Barbados,  with 
its  gay  freshness  and  brilliancy  and  slight  elevation — 
Grenada,  more  solemn,  with  green  everywhere,  hills  and 
valleys  covered  with  cacao  plantations  and  trees  of  all 
kinds.  When  we  landed,  St  George's  was  not  a  hotbed 
of  fever ;  it  was  as  free  from  the  danger  of  yellow  fever 
as  Southampton.  Yet,  when  my  mother  was  there  her 
sister  had  just  got  over  the  usual  attack  of  the 
acclimatising  fever  of  Grenada.  Yellow  fever  was 
then  endemic,  as  well  as  in  all  the  West  Indian  Islands, 
as  we  have  seen.  The  colony  was  also,  moreover,  in 
those  days  badly  plagued  with  malaria ;  one  sister  got 
yellow  fever,  the  other — my  mother — malaria,  both 
within  a  few  weeks  of  landing.  And  this  was  the 
usual  occurrence  at  that  period.  But  to-day  how 
different ! 

It  is  clear,  from  examination  of  the  old  military 
records,  that  yellow  fever  was  probably  endemic  up 
to  the  fifties,  when  it  appears  to  have  died  out. 

In  the  year  1817  the  mortality  of  the  troops  from 
yellow  fever  is  given  as  8 '2  per  cent.,  and  in  the  year 
1818  as  21  per  cent. 

An  extract  from  the  Blue-book  of  the  year  1881 
shows  that  a  few  cases  of  the  endemic  fever  occurred 
which,  from  the  description,  appear  to  have  been  cases  of 
yellow  fever.  Mr  Edward  Drayton,  of  Grenada,  also 
confirms  this  from  personal  recollection. 

Since  then  the  cases  which  have  occurred  have  been 


EARLY  HISTORY  OF  YELLOW  FEVER  151 

all  imports.  There  is  no  longer  question,  therefore,  that 
yellow  fever  has  died  out,  and  in  my  opinion  the  great 
factor  which  has  led  to  this  has  been  the  introduction 
first  in  1837  of  a  pipe-borne  water-supply.  This  water 
was  laid  on  to  only  four  standpipes  and  not  to  any  houses. 
It  proved  inadequate  and  was  augmented  in  the  year 
1879,  and  later  again  in  1907,  and  now  there  are  thuty 
standpipes  and  2-10  house-services  in  the  town.  I  think 
that  there  can  be  very  little  doubt  that  the  ample  pipe- 
borne  water-supply  of  1879  was  the  death  of  endemic 
yellow  fever,  as  also  of  the  diseases  contracted  through 
drinking  the  polluted  well-water  of  the  old  period. 

Hoiv  yellow  fever  was  supposed  to  have  arrived  in 
Grenada  in  the  18th  Century. — The  following  curious 
and  interesting  narrative  dates  back  to  1793.  Dr 
Chisholm,  a  well-known  writer  on  yellow  fever  of  that 
period,  gives  it  as  his  opinion  that  up  till  then  all  cases 
of  yellow  fever  in  the  West  Indies  had  arisen  from  marsh 
miasmata  and  were  not  contagious.  In  1793,  however, 
a  7iova  pestis,  "a  peculiar,  original,  foreign  plague, 
recently  generated  and  utterly  unknown  before,  endued 
with  a  distinct  character,  possessing  new  powers  of 
devastation,  and  capable  of  propagating  itself  throughout 
this  world,"  was  introduced  into  Grenada  on  19th 
February  1793,  by  a  ship  which  possessed  the  doubtful 
name  of  HanJtey.  The  new  disease  did  not  stop  at 
Grenada,  but  Grenada  became  from  that  date  the 
centre  from  which  yellow  fever  spread,  not  only 
throughout  the  West  Indies,  but  to  Europe  and 
America  as  well. 

The  wanderings  of  the  good  ship  Hankey  are  thus 


152  HEALTH  PROGRESS  IN  GRENADA 

narrated.  She  left  England  in  April  1792,  in  company 
with  the  ship  Calypso.  She  was  chartered  by  the 
Sierra  Leone  Company,  and  had  a  cargo  of  stores  and 
adventurers  who  were  seeking  to  found  a  settlement  in 
the  island  of  Bulama,  near  the  mouth  of  the  Rio  Grande, 
on  the  West  African  coast.  On  arrival  at  Bulama, 
the  adventurers  on  board  found  they  could  not  go 
ashore,  on  account  of  the  bloodthirsty  and  cannibal- 
istic tendencies  of  the  inhabitants.  They  were  obliged, 
therefore,  to  live  on  the  ship  to  the  number  of  200, 
including  men,  women,  and  children.  Some  malignant 
fever  soon  broke  out  amongst  them,  and  when  ultimately 
she  had  to  leave,  there  was  only  the  captain,  mate,  and 
two  seamen  left  alive  to  navigate  the  ship.  She  put  to 
sea  for  the  West  Indies,  and  on  the  way  fell  in  with  a 
Avarship,  from  which  assistance  was  obtained,  with  the 
result  that  the  fever  also  broke  out  on  the  warship — at 
least,  so  it  is  narrated.  At  last,  when  the  Hanhey  arrived 
at  St  George's,  all  those  who  went  near  her  also  got 
fever.  Then  about  the  middle  of  April  1893,  the 
disease  began  to  appear  ashore,  introduced,  so  the 
narrative  states,  by  a  negro  wench  who  took  in  sailors' 
clothes  to  wash.  The  disease  then  spread  to  the 
garrisons  and  held  sway  during  May,  June,  and  July, 
and  from  Grenada  the  disease  was  carried  to  Jamaica, 
St  Domingo,  and  Philadelphia.  Such  is  the  history  of 
the  introduction  of  yellow  fever — Bulam  fever — into 
Grenada  and  other  West  Indian  islands  by  the  fateful 
ship  Hanhey. 

The  introduction   of  the  pipe-borne  water  at  once 
did  away  with  the  old-time  rain-water  barrels,  concrete 


YELLOW  FEVER  153 

cisterns,  wells,  and  all  the  odds  and  ends  for  storing 
water. 

And  in  St  George's,  owing  to  the  steep  inclines,  there 
is  a  comparatively  good  flushing  of  all  drains,  and  there 
is  in  consequence  no  tendency  to  the  formation  of  pools. 

And  there  seems  little  doubt  that  St  George's  has 
been  as  remarkably  free  from  Stegomyia  for  some 
considerable  time  past  as  it  is  to-day. 

Stegomyia  Survey. — I  started  my  survey  on  1st  April, 
setting  out  with  the  Medical  Officer,  Dr  G.  W.  Paterson, 
Mr  Anthony  De  Freitas,  and  Inspector  Smith  and 
Sergeant  Briggs.  Our  first  tour  of  inspection  embraced 
the  houses  of  the  poor  and  very  poor ;  later  we  examined 
those  of  the  better  class.  Altogether,  I  examined  80 
houses  in  St  George's.  These  contained  116  recep- 
tacles, consisting  of  barrels,  washtubs,  jars,  kerosene 
tins,  and  receptacles  for  flowers,  such  as  calabashes, 
glass  vases,  etc.  The  tubs  and  barrels  were  for  the 
most  part  clean ;  the  worst  offenders  were  glass  vases, 
used  for  striking  croton  cuttings.  I  found  larvse  of 
Stegomyia  calopus  in  five  out  of  the  eighty  houses.  From 
this  it  is  evident  that  the  total  number  of  water 
receptacles  is  not  great,  the  house  taps  and  standpipes 
having  done  away  with  the  necessity  of  storing  water, 
and  the  proportion  of  Stegomyia  is  very  small.  This  is 
one  great  reason  why  Grenada  has  escaped  yellow  fever. 

Yellow  Fever. — Two  imported  cases  of  yellow  fever 
occurred  in  1907  ;  both  had  come  from  Trinidad,  and  the 
evidence  is  in  favour  of  their  having  contracted  the 
disease  in  Trinidad  in  the  spring  of  1907  ;  one  was  in  a 
white,  the  other  was  in  a  black  subject.     The  cases 


154  HEALTH  PROGRESS  IN  GRENADA 

were  properly  dealt  with,  and  no  secondary  cases 
occurred. 

Antilarval  and  Yellow  Fever  Measures. — Under  the 
Public  Health  Ordinances,  1902  and  1905,  regulations 
were  made,  24th  April  1907,  to  deal  with  yellow  fever, 
in  respect  to  early  notification,  fumigation,  and  the  pre- 
vention of  the  breeding  of  Stegomyia  larvae ;  these 
measures  were  hastened  on,  owing  to  the  outbreak  of 
yellow  fever  in  Trinidad.  On  30th  Aug  'st  1907,  a 
further  regulation  was  issued  for  the  prevention  of  yellow 
fever.  Since  my  visit,  May  1909,  useful  regulations 
dealing  with  mosquito  larvae  have  been  passed,  making 
it  a  punishable  offence  to  have  mosquito  larvae  on  the 
premises,  forbidding  the  keeping  of  stagnant  water,  and 
insisting  upon  screening.  The  regulations  also  recom- 
mended the  use  of  larvae -destroying  fish.  (For  further 
details,  see  Appendix.) 

I  visited  the  small  yellow  fever  isolation  hospital ;  it 
is  small,  but  thoroughly  well  screened  and  efi&cient. 

Health  Administration. 

Population. — Estimated  at  71,504  on  31st  December 
1907. 

Division  of  Island. — The  colony  is  divided  into  six 
parishes,  and  in  addition  to  these  there  are  certain  small 
dependencies,  known  as  the  Grenadines,  of  which  the 
largest  is  Carriacou.  The  following  is  a  list  of  the 
parishes : — 


St  George's. 
St  David's. 
St  Andrew's. 


St  Patrick's. 
St  Mark's. 
St  John's. 


SANITARY  ADMINISTRATION 


155 


There  are  ten  medical  districts,   in  charge  of  the 
following  officers : — 


District  No. 

1       . 

Dr  G.  W.  Patei'son. 

No. 

2       . 

Dr  the  Hon.  E.  F.  Hatton 

No. 

3       . 

Dr  T.  C.  Orford. 

No. 

4      . 

Dr  R.  D.  O'Neale. 

No. 

5       . 

Dr  H.  Bishop. 

No. 

6       . 

Dr  W.  A.  D.  Whiteman. 

No. 

7      . 

Dr  N.  S.  Durrant. 

No. 

8       . 

Dr  H.  J.  L.  Bennett. 

No. 

9       . 

Dr  G.  N.  Alexis. 

No. 

10       . 

Dr  Dunbar  Hughes. 

There  is  also  a  house  -  surgeon  at  the  colony- 
hospital  in  St  George's,  who  is,  at  present,  Dr  J.  V. 
de  Coteaa 

Principal  Towns, — The  principal  towns  are  : — 


St  George's    . 

Population 

(1901 

census)  5184 

Grenville 

» 

1414 

Gouyave 

!) 

2455 

Sauteurs 

» 

1139 

Victoria 

}> 

1704 

Hillsborough  (Carriacou) 

)} 

302 

There  is  a  board  of  health. 

The  Governor  and  the  members  of  the  Executive 
Council  form  the  general  board  of  health  of  the 
colony.  There  are  six  district  health  authorities, 
consisting  of  the  medical  officer,  the  chief  and  sub- 
inspectors  of  police  and  other  official  and  unofficial 
members.  Fixed  monthly  meetings  are  held.  Excellent 
annual  medical  reports  are  made  to  the  Colonial 
Secretary  from  each  of  the  districts  by  the  medical 
officer  in  charge,  as  also  of  all  the  charitable  insti- 
tutions. 


156  HEALTH  PROGRESS  IN  GRENADA 

Yearly  reports  of  the  Registrar- General  are  also 
published,  and  include  births,  deaths,  and  marriages. 

There  are  two  Public  Health  Ordinances,  1902  and 
1905,  and  upon  the  authority  of  these,  regulations  and 
bye-laws  have  been  issued. 

The  St  George's  District  Board  has  framed  sanitary 
and  rubbish  bye-laws,  dealing  with  : — 

1.  Removal  of  night-soil. 

2.  Closets. 

3.  Offensive  matter. 

4.  Purifying  houses  ;  and 

5.  Adulteration  of  milk  (Appendix). 

A  very  useful  handbill  has  been  issued  by  the 
St  George's  District  Board  of  Health,  pointing  out  the 
danger  of  unboiled  water  and  flies  in  connection  with 
the  spread  of  typhoid  and  dysentery. 

A  memorandum  was  also  issued  by  the  Governor, 
drawing  the  attention  of  district  medical  officers  to 
the  importance  of  furnishing  monthly  returns  of  infec- 
tious diseases,  in  order  to  help  to  stamp  out  all  such 
sickness.  Their  attention  was  also  drawn  to  malarial 
fevers. 

Malaria. — In  Barbados  we  have  seen  that  there  is 
an  ideal  porous  soil  which  prevents  the  formation  of 
small  puddles,  and  that  the  ponds  which  exist  are  well 
stocked  with  fish.  I  mentioned  that  there  were  no 
Anophelines,  and  that  endemic  malaria  did  not  exist. 
What  a  contrast  is  Grenada !  a  stiff"  clay  soil,  numerous 
hills  and  valleys,  the  whole  island  threaded  with  streams 
innumerable,  and  here  and  there  a  marsh.  It  is  not, 
therefore,  to  be  wondered  at  that  Anophelines  are  present 


MALARIA  IN  GRENADA  157 

and  that  Malaria  is  the  chief  disease  of  the  island.  It 
seems  incomprehensible  that  there  should  be  still 
doubters  of  the  mosquito  doctrine  when  two  parallel 
natural  experiments  like  Grenada  and  Barbados  exist 
side  by  side. 

I  have  made  up,  from  various  sources,  the  following 
annual  malarial  death-rates  : — 


1899 

71  deaths 

1904 

99  deaths 

1900 

80 

» 

1905 

.   110   „ 

1901 

75 

)} 

1906 

.   175   „ 

1902 

115 

)} 

1907 

.   120   „ 

1903 

110 

1  _ 

J  •  j^i  _  ' 

Malaria  is  most  prevalent  in  the  rainy  season. 

In  1907,  Dr  G.  W.  Paterson,  in  his  annual  report 
for  No.  1  District,  St  George's,  states  that  there  was  a 
marked  reduction  in  the  number  of  cases  compared  with 
the  previous  year ;  thus  in  1907  there  were  317  cases  and 
12  deaths,  as  against  681  cases  and  22  deaths  in  1906. 
In  this  district  the  chief  sources  of  malaria  are  the  marsh 
lands  in  the  Tanteen  and  Queen's  Park.  In  the  same 
No.  4  District  malarial  fever  was  severe  in  1907.  In  the 
No.  6  District  1119  cases  of  malaria  are  reported.  In 
addition  to  the  endemic  malaria,  there  is  also  a  virulent 
imported  form.  Drs  N.  S.  Durrant  and  H.  J.  L.  Bennett, 
who  have  taken  particular  note  of  this,  believe  that  the 
returning  labourers  have  brought  it  back  with  them  from 
Panama.  If  this  is  so,  it  is  interesting,  because  in  all 
human  probability  these  same  workmen  would  have  had 
the  malaria  common  to  Grenada  in  their  childhood  or  at 
some  time  prior  to  leaving  for  the  Canal  zone,  but  were 
not  rendered  immune  therebv. 


158  HEALTH  PROGRESS  IN  GRENADA 

Antimalarial  Measures. — The  first  offensive  blow  to 
the  Anoplielines  was  the  mtroduction  of  a  pipe-borne 
water-supply  to  the  towns  of  St  George's,  Gouyave,  and 
Grenville,  which  did  away  with  odd  collections  of  water. 
In  the  second  place,  more  land  has  been  put  under 
cocoa,  and  this  has  necessitated  better  drainage,  and  I 
have  been  informed  by  planters  and  doctors  that  since 
cocoa  has  replaced  cane,  there  has  been  an  improve- 
ment in  the  number  of  malaria  cases. 

Thirdly,  the  Government  and  the  district  medical 

officers  are  alive  to  the  necessity  of  action,  and  are  now 

only  kept  back  through  want  of  funds.     The  following 

circular  was  issued  to  district  medical  officers  in  July 

1906,  requesting   them   in   future   to   include  in   their 

annual  reports  the  mention  of  any  measures  taken  to 

eradicate  malarial  fever.     It  runs  as  follows  : — 

I  am  directed  by  His  Excellency  the  Governor  to 
communicate  to  you  the  following  extract  from  a 
circular  dispatch  from  the  Secretary  of  State  for  the 
Colonies,  dated  6th  June  1906,  respecting  the  manner 
in  which  reports  of  the  measures  taken  to  eradicate 
malarial  fevers,  etc.,  are  in  future  to  be  dealt  with  : — 

3.  It  has  been  contemplated  to  issue  annually  a  report  of  the 
work  done  by  means  of  the  funds  subscribed  by  certain  Colonies  and 
Protectorates,  and  administered  by  the  Advisory  Board  of  the 
Tropical  Disease  Research  Fund,  which  was  constituted  by  my 
predecessor.  I  would  suggest  that  the  Advisory  Board  should  utilise 
in  their  annual  report,  which  would  be  issued  early  in  each  calendar 
year,  any  reports  on  the  measures  taken  to  eradicate  malarial  fever, 
yellow  fever,  and  other  mosquito-borne  diseases,  which  Colonial 
Governments  may  be  able  to  supply.  The  report  of  the  Advisory 
Board  will  be  for  the  academic  year  1st  October  to  30th  September, 
and  it  would  therefore  be  sufficient  if  a  section  dealing  with  these 
measures  could  be  inserted  in  the  usual  annual  medical  report  of  each 
Colony  or  Protectorate  which  is,  or  should  be,  always  received  at  the 
Colonial  Office  before  the  autumn  of  the  succeeding  year. 


ANTIMOSQUITO  MEASURES  159 

4.  This  special  report  or  section  of  a  report  would  be  supple- 
mentary to,  and  not  in  substitution  for,  the  returns  now  included  in 
the  annual  report.  It  should  give  a  concise  account  of  the  nature 
and  cost  of  all  measures  of  the  kind  indicated  which  have  been  begun 
or  were  in  progress  during  the  period  in  question,  whether  by 
legislation,  public  works,  education,  sanitation  or  otherwise,  and  it 
should,  if  practicable,  give  figui-es  showing  the  comparative  salubrity 
of  different  localities,  and  the  varying  rates  of  death  or  disease  from 
malaria,  etc.,  among  the  several  classes  of  the  community.  Any 
really  accurate  and  trustworthy  figures  as  to  the  results  of  precautions 
taken  against  mosquito-borne  infection  should  be  of  value. 

I  am  to  request  that  in  future  in  your  annual  report 
you  will  be  so  good  as  to  include  mention,  in  the  manner 
indicated,  of  any  measures  taken  in  your  district. 

Edward  Drayton, 

Colonial  Secretary. 

In  company  with  Dr  Paterson,  I  inspected  the 
Anopheline  breeding  grounds  in  the  St  George's  District, 
viz.,  the  Botanic  Gardens,  and  the  Tanteen  and  Darbeau 
swamps.  There  is  very  little  doubt  that  canalisation 
of  these  swamps,  and  the  admission  of  sea-water  and 
fish,  would  do  much  to  flush  and  drain  them  and  to  rid 
them  of  larvae.  On  1st  April  1909,  "millions"  were 
introduced  from  Barbados  into  the  Botanical  Gardens, 
to  deal  with  the  water  collections  there. 

As  Grenada  has  done  so  remarkably  well  in  con- 
nection with  yellow  fever,  I  do  hope  it  will  be  en- 
couraged to  continue  the  fight  against  the  Anophelines, 
and  so  render  Grenada  one  of  the  most  fertile,  and  at 
the  same  time  most  healthy,  of  the  agricultural  stations 
in  the  West  Indies. 

Grenada  is  the  chief  of  the  three  Windward 
Islands,  and  coming  from  Bardados,  the  change  to 
colonies  where  order  prevails  in  the  medical  adminis- 


160      HEALTH  PROGRESS  IN  GRENADA 

tration  is  very  striking.  There  are  annual  medical 
reports,  and  one  can  see  at  a  glance  what  is  being  done 
to  reduce  sickness  rates,  what  use  is  being  made  of 
the  medical  institutions,  and  so  on.  The  medical 
reports  are  well  reasoned  out  and  clearly  drawn  up. 
The  medical  organisations  of  Grenada,  St  Vincent,  and 
St  Lucia  are  not  expensive.  It  is  not  too  much  to 
say,  that  owing  to  their  existence,  the  few  imported 
cases  of  yellow  fever  which  did  occur,  did  not  spread 
as  they  undoubtedly  did  in  Bardados.  In  this  respect 
alone  the  three  Windward  Islands  would  have  recouped 
themselves  over  and  over  again  for  the  necessary 
expenditure  on  the  medical  staflPs.  Further,  useful 
medical  investigations  have  been  made  upon  diseases 
of  immense  importance  to  these  colonies.  In  Grenada 
I  visited  the  Yaws  Hospital,  where  patients  are 
carefully  watched  and  treated,  and  in  the  general 
hospital  I  saw  many  cases  of  ankylostomiasis. 

In  January  1908,  the  Colonial  Secretary  issued  a 
copy  to  district  medical  officers,  of  the  Secretary  of 
State's  dispatch  relative  to  measures  taken  against 
ankylostomiasis  in  the  colony  (see  Appendix).  The 
disease  has  fortunately  not  assumed  serious  proportions. 

Plague. — The  administration,  determined  to  be  fore- 
armed, have  taken  wise  measures  against  rats.  A 
circular  was  issued  in  June  1903  to  district  boards, 
pointing  out  the  relationship  of  rats  to  plague,  and  the 
steps  which  should  be  taken  to  exterminate  them.  At 
the  same  time,  rat  virus  and  rat  traps  were  imported 
(see  Appendix).     No  cases  of  plague  occurred. 

Modified  Smallpox  and  Eruptim  Fever  and  Vaccina- 


TUBERCULOSIS  161 

tion.-T-FoT  interesting  information  upon  these  diseases, 
see  Appendix. 

Tuberculosis. — Attention  is  directed  to  the  extreme 
reluctance  of  the  natives  to  ventilation,  and  in  conse- 
quence, to  the  still  considerable  prevalence  of  the 
disease. 


CHAPTER  XII 

HEALTH   PROGRESS   AND   ADMINISTRATION   IN   ST   VINCENT 

I  ARRIVED  in  St  Vincent  on  6th  April,  and  immediately 
established  my  office,  with  the  permission  and  kindness 
of  the  then  administrator,  His  Honour  E.  J.  Cameron, 
C.M.G.,  in  Government  House. 

St  Vincent. — Estimated  population  (on  31st  March 
1908),  51,779. 

The  island  is  divided  into  six  parishes,  as  follows  : — 
Charlotte  Parnsh  comprises  the  lands  extending  from 
the  river  called  the  lambou  to  Kingstown  North  River, 
where  it  empties  itself  into  the  sea,  and  running  up  the 
bed  of  the  last-named  river  until  it  divides,  and  from 
thence  continuing  along  the  course  of  the  northern 
branch  of  the  river  to  the  great  ridge  of  mountains 
running  through  the  centre  of  the  island  of  St  Vincent. 

St  Andrew's  Parish  comprises  the  lands  extending 
from  the  river  called  the  Kingstown  North  River,  and 
from  the  southern  branch  thereof  unto  the  high  ridge  to 
the  northward  of  Queen's  Valley,  which  divides  the 
Valley  from  Rutland  Valley,  and  running  along  the 
ridge  until  it  meets  the  great  ridge  of  mountains  which 
runs  through  the  centre  of  the  island  of  St  Vincent. 

162 


PARISHES  OF  ST  VINCENT  163 

St  Patrick's  Parish  extends  from  the  ridge  to  the 
northward  of  Queen's  Valley  unto  the  high  ridge  to  the 
northward  of  Cumberland  Valley,  commonly  called 
Byam's  Hill,  and  shall  run  along  the  last-named  ridge 
until  it  meets  the  great  ridge  of  mountains  which  runs 
through  the  centre  of  the  island  of  St  Vincent. 

St  David's  Parish  extends  from  the  last-mentioned 
and  northern  boundary  of  St  Patrick's  Parish  unto  the 
northern  boundary  of  Charlotte  Parish. 

The  Grenadines  Parish  comprises  the  island  of 
Bequia  and  such  other  of  the  islands  within  this  colony, 
commonly  called  the  Grenadines,  as  lie  to  the  northward 
of  the  island  of  Carriacou. 

For  medical  purposes  the  colony  is  divided  into  six 
districts,  as  follows  : — 

Kingstown  District.  To  comprise  the  town  of 
Kingstown  as  defined  by  section  73  of  Ordinance  No. 
11  of  1897,  and  that  part  of  St  Andrew's  Parish  which 
lies  to  the  south  of  the  road  leading  to  Fort  Charlotte. 

No.  1  District.  That  part  of  St  George's  Parish 
other  than  the  town  of  Kingstown  which  lies  to  the 
north  and  west  of  Glen  River  and  south  of  the  Vigie 
Eidge,  also  the  town  of  Calliaqua  and  area  within  a 
radius  of  440  yards  from  the  Police  Station  in  that 
town ;  the  Parish  of  St  Andrew,  south  of  ridge  running 
from  Biaha  point  to  Mount  St  Andrew,  separating 
Buccament  Valley  from  Clare  Valley,  etc.,  but  exclusive 
of  that  portion  of  the  parish  included  in  Kingstown 
District,  also  the  islands  of  Bequia,  Mustique, 
Balliceaux,  and  Battowia. 

No.  2  District.     The  Parishes  of  St  Patrick  and  St 


164  HEALTH  PROGRESS  IN  ST  VINCENT 

David  and  such  part  of  the  Parish  of  St  Andrew  as  is 
not  included  in  the  Kingstown  and  No.  1  Districts. 

No.  3  District.  That  part  of  St  George's  Parish  not 
included  in  No  1  District;  and  portion  of  Charlotte 
Parish  lying  to  south  of  a  line  formed  by  the  spur  which 
runs  from  the  Petit  Bonhomme  dividing  Greigg's 
Settlement  from  Mesopotamia  Valley  to  source  of 
Biabou  Kiver,  thence  following  that  river  to  the  sea,  and 
embracing  the  whole  of  the  Mesopotamia  Valley. 

No.  4  District.     The  remainder  of  Charlotte  Parish. 

No.  5  District.  The  Grenadine  islands  included  in 
the  Government  of  this  colony  other  than  those 
included  in  the  No.  1  District. 

The  principal  towns  are  : — 


Kingstown 

Estimated 

population. 

6100 

Georgetown    . 

)) 

}) 

2100 

Calliaqua 

» 

33 

860 

Layou 

)} 

33 

1070 

Barrouallie 

» 

33 

1560 

Chateaubelair 

» 

33 

1680 

Medical  Organisation. 

Each  district  government  has  a  medical  officer, 
appointed  by  the  Administrator,  on  selection  (in  the 
case  of  those  purveyed  from  England)  by  the  Secretary 
of  State  for  the  Colonies.  The  following  is  a  list  of  the 
present  medical  officers  : — 


Kingstown  District 

Dr  C.  H.  Durrant. 

District  No.  1 

Dr  Dodds. 

„       No.  2       .         . 

Dr  P.  F.  Cremona. 

„       No.  3       . 

Dr  P.  Gray  Marshall 

District  No.  5  is  visited. 


HEALTH  ADMINISTRATION  165 

The  No,  4  District  is  at  present  vacant,  owing  to 
the  recent  death  of  Dr  C.  R.  Pike ;  the  medical  duties 
of  the  district  are,  however,  performed  by  Dr 
Cremona. 

Dr  C.  H.  DmTant  is  therefore  the  medical  officer  of 
the  principal  town. 

Health  Administration. 

On  6th  April,  I  met  the  Kingstown  Town  Board, 
which  acts  as  the  local  health  authority  for  Kingstown. 

The  chairman  of  the  Board  is  Mr  W.  C,  Forde,  and 
there  are  four  other  members. 

The  warden  is  Rosemont  G,  Cropper. 

There  are  two  permanent  inspectors — the  warden 
and  the  supervisor. 

In  emergencies,  four  to  six  additional  inspectors  are 
appointed. 

Thus  it  will  be  noticed  that  whilst  Dr  Durrant  is 
principal  medical  officer  for  Kingstown,  there  is  also  a 
local  health  authority  for  Kingstown. 

Public  Health  Acts,  Ordinances,  etc. — As  the  Public 
Health  Act  of  1865  did  not  contain  clauses  relating  to 
mosquito  destruction,  an  Ordinance,  No.  3,  of  1901, 
was  passed  to  repeal  it,  and  regulations  were  framed 
in  1907  to  deal  according  to  modern  methods  with 
yellow  fever  and  mosquitos.  A  new  ordinance  is 
now  being  prepared  for  1909  with  provisions  against 
stagnant  water  and  larvae  ;  also  with  provisions  relating 
to  the  proper  storage  and  control  of  water,  the  notifi- 
cation and  the  prevention  of  the  spread  of  infectious 
diseases. 


166  HEALTH  PROGRESS  IN  ST  VINCENT 

Non-compliance  with  the  antilarval  regulations  is 
visited  with  a  penalty  not  exceeding  £20. 

It  goes  without  saying,  that,  like  all  the  other  sister 
islands,  St  Vincent  is  very  beautiful.  The  valleys  and 
the  hills  are  well  covered  with  woods,  and  numerous 
streams  pass  through  the  valleys  on  their  way  to  the 
sea.  In  Barbados  I  visited  all  the  parishes  throughout 
the  island  on  motor  car,  in  Grenada  I  drove  through  the 
island  from  St  George's  to  Grenville,  in  both  cases 
getting  a  good  idea  of  the  nature  of  the  country.  In 
St  Vincent,  by  means  of  a  rowing  boat,  in  company  with 
the  late  Dr  Branch,  I  was  able  to  get  a  good  view  of  the 
contour  and  nature  of  the  island  on  all  sides.  There  is 
evidence  of  past  volcanic  activity;  every  stratum  tells 
its  tale.  The  chief  town,  Kingstown,  is  clean,  and  what 
I  have  said  of  St  George's  and  Bridgetown  holds  equally 
good  for  Kingstown,  St  Vincent. 

The  old-time  fever  den  is  now  a  thing  of  the  past. 
Yellow  fever  is  not  endemic ;  although,  as  we  have  seen 
in  the  early  chapters,  time  was  when  it  was  always 
recurring. 

In  1817  the  annual  percentage  mortality  from  fever 
in  the  garrison  is  stated  as  1*12.  In  1822  one  case  of 
yellow  fever  is  reported,  etc. 

The  Yellow  Fever  Outbreak,  1909,  and  the  Measures 
taken  to  Stamp  it  Out. — Five  cases  were  reported  :  four  in 
Kingstown  and  one  in  the  village  of  Bequia. 

With  regard  to  the  origin  of  these  cases,  Dr  Branch 
was  of  opinion  that  a  mild  case  of  yellow  fever  was 
imported  from  Barbados  in  one  of  the  numerous 
schooners  which  trade  between  the  two  islands.     For 


IMPORTED  CASES  OF  YELLOW  FEVER  167 

although  yellow  fever  was  not  reported  from  Barbados 
at  the  tirae  when  the  first  two  suspected  cases  were  seen, 
it  was  so  very  soon  afterwards  (12th  October  1908).  He 
states  it  was  unlikely  to  have  been  introduced  from 
Trinidad  or  Martinique,  as  these  places  are  about  three 
days'  sail,  whilst  Barbados  is  only  fifteen  hours'  sail,  and 
there  is  no  trade  with  Martinique.  Trinidad  is  not 
excluded,  however,  but  Dr  Branch  thinks  it  improbable. 
Dr  Durrant  also  states  that  it  would  have  been  unlikely 
for  a  case  to  have  come  from  Trinidad,  as  at  the  time 
there  was  a  very  rigid  examination  of  all  arrivals  from 
Trinidad,  owing  to  the  fact  that  there  was  plague ;  it 
would,  therefore,  have  been  improbable  that  a  case  of 
fever  should  have  escaped  the  medical  inspection. 

In  view  of  the  facts  and  the  smallness  of  the  outbreak, 
it  is  most  reasonable  to  suppose  that  yellow  fever  was 
introduced ;  it  was  kept  small  and  soon  extinguished. 
And  for  the  promptness  with  which  it  was  dealt  with, 
we  must  here,  as  also  pointed  out  in  the  case  of 
Grenada,  thank  the  more  perfect  and  up-to-date  medical 
organisation. 

The  precautionary  measures  taken  were  as  follows  : — 
Disinfection  and  Precautionary  Measures. — 

Case  No.  1. — The  house  and  shops  underneath  were 
fumigated  on  date  of  death,  10th  September. 
The  adjoining  houses  were  fumigated  the  next 
day.  Contacts  were  kept  under  surveillance. 
House-to-house  visitation  was  carried  out  in 
two  blocks  of  the  town,  in  the  neighbourhood  of 
the  residence.  On  11th  September,  and  on  the 
same  and  following  days,  the  sanitary  inspectors 
went  through  the  whole  of  Kingstown  directing 


168  HEALTH  PROGRESS  IN  ST  VINCENT 

and  enforcing  the  clearing  of  bush,  trimming  of 
trees,  clearing-up  of  broken  bottles,  etc.,  etc. 

Case  No.  2. — The  house  was  fumigated  on  date  of 
death,  10th  September,  as  also  the  adjacent 
house.  Contacts  were  kept  under  surveillance. 
The  yards  of  the  adjacent  house  were  cleaned 
up,  and  all  likely  mosquito  breeding  places 
attended  to. 

Case  No.  3. — The  house  was  fumigated  on  2nd 
October,  the  adjoining  houses  on  the  next 
day.  Contacts  were  kept  under  surveillance. 
House-to-house  visitation  in  the  neighbour- 
hood was  carried  out  on  the  13th  and  on  18th 
October. 

Case  No.  4. — Patient  was  isolated  in  his  own  room 
by  effective  mosquito  screening  on  the  24th 
October,  and  the  rest  of  the  house  was  sealed 
and  fumigated  on  the  same  day.  Contacts  were 
kept  under  surveillance.  Adjoining  houses 
were  fumigated  on  the  25th  October. 

Case  No.  5. — The  house  in  Kingstown  in  which  the 
patient  died  was  not  fumigated,  as  the  period  of 
infection  had  passed  when  the  patient  was 
brought  in.  The  medical  ofl&cer,  Dr  Durrant, 
visited  Bequia  on  the  16th  and  17th  December 
and  fumigated  the  house  in  which  the  patient 
had  been  taken  sick,  and  another  house  to  which 
she  had  been  removed  during  the  illness.  He 
also  oiled  a  water  cistern  at  the  former  house. 
Contacts  were  examined  on  both  days  and 
found  well.  He  also  drew  the  attention  of  the 
local  health  authority  to  other  necessary  sani- 
tary precautions.  He  made  enquiries  as  to 
origin  of  infection,  but  was  unable  to  trace 
anything  that  would  throw  light  on  the  subject. 


r^ 


MOSQUITO  SURVEY  169 

On  the  28th  and  29th  December,  Dr  Durrant 
again  visited  Bequia,  examined  contacts,  and 
found  them  free  from  symptoms  of  infectious  or 
contagious  disease.  Further  enquiry  failed  to 
discover  a  single  case  of  fever. 

There  is  provision  in  the  Colonial  Hospital  for  the 
isolation  of  cases  of  yellow  fever.  The  screened  ward, 
which  I  examined,  was  in  eveiy  way  effective. 

At  the  quarantine  station  there  is  also  a  well- 
screened  house.  There  is  in  addition  an  excellent 
observation  station  for  suspects. 

Mosquito  Survey — Kingstown. 

I  inspected  39  houses  situated  in  Bentinck  Park,  in 
the  Square,  Eose  Place  and  Lime  Kiln  Bay,  Queen 
Street  and  Middle  Street. 

The  yards  were,  on  the  whole,  clean,  containing  but 
few  odd  receptacles.  They  had  evidently  been  looked 
after.  Many  of  the  houses  had  standpipes,  and  stand- 
pipes  were  fixed  at  intervals  along  the  roadways.  The 
result  is  that  the  water-containers  are  not  numerous,  as 
there  is  no  necessity  for  them.  I  examined  5  barrels, 
12  washing- tubs,  15  jars,  and  20  zinc  buckets,  and 
larvae  were  found  only  three  times.  No  rain-water  or 
well-water  is  used  systematically. 

In  this  tour  of  inspection,  I  was  accompanied  by  Dr 
Branch  and  the  warden,  E,.  G.  Cropper,  Esq. 

I  also  visited  Layou  and  Barrouallie,  along  the 
coast,  with  Dr  Branch. 

At  Layou  we  were  met  by  the  warden,  the  Eev.  Mr 


170  HEALTH  PROGRESS  IN  ST  VINCENT 

Paterson.  We  examined  20  houses ;  the  yards  were 
somewhat  Deselected. 

The  water-supply  was  derived  from  the  river.  No 
standpipes  were  found.  I  examined  6  barrels,  2  tubs, 
15  jars,  and  12  buckets  and  5  kerosene  tins,  etc.  Larvae 
were  found  on  two  occasions. 

At  Barrouallie  I  visited  two  houses  and  examined  10 
barrels,  2  tubs,  5  buckets,  8  jars,  and  other  odd 
receptacles.  Larvse  were  found  in  all  the  barrels. 
The  water-supply  is  obtained  from  a  spring,  and 
there  are  also  some  wells  in  the  rainy  season. 
E-oof-water  is  collected.  Mr  James  Gould  is  the 
warden. 

It  would  be  a  great  boon  to  introduce  a  proper 
water-supply  for  both  places,  and  to  appoint  sanitary 
inspectors. 

I  inspected  Calliaqua  with  Dr  Durrant,  and  on  the 
way  examined  the  houses  along  Sion  Hill.  They 
nearly  all  of  them  have  barrels  for  holding  rain-water 
or  drinking-water.  The  majority  contained  larvse.  This 
district  was  the  worst  part  of  Kingstown  as  regards 
larvae,  and  this  is  due  entirely  to  the  fact  that  there  are 
no  standpipes. 

At  Calliaqua  I  inspected  19  houses.  Barrels  were 
relatively  very  numerous.  I  examined  6  barrels,  10 
buckets,  and  6  jars.  There  were  also  3  wells  and 
numerous  old  receptacles  which  would  breed  larvae  in 
the  rainy  season.  Larvae  were  present  in  two  houses. 
This  town  is  weak  from  a  yellow  fever  defensive  point 
of  view.  A  proper  water-supply  is  most  desirable,  and 
also  a  sanitary  inspector. 


MOSQUITO  SURVEY  171 

I  visited,  with  Dr  Branch  and  Warden  Cropper, 
the  market,  and  examined  several  houses  and  yards.  I 
found  in  them  7  barrels,  7  tubs,  and  3  buckets.  Larvae 
were  found  three  times.  The  yards  were  for  the  most 
part  badly  kept  and  contained  numerous  odd  recep- 
tacles. One  yard  contained  a  lot  of  barrels.  There 
was  much  room  for  improvement  in  this  neighbour- 
hood. 

Summary  of  Mosquito  Ins'^ection. — Kingstown  and 
Sion  Hill: — 

60  houses.  23  buckets. 

20  barrels.  15  jars. 

19  tubs. 

Larvae  in  9  houses. 

Towns  of  Layou,  Barroiiallie,  and  Calliaqua— 


65  houses. 

22  barrels. 

4  tubs. 

29  jars. 


27  buckets. 
5  kerosene  tins. 
3  wells. 


Larvae  in  14  houses. 


As  in  Barbados  and  Grenada  and  the  other  West 
Indian  islands,  so  in  St  Vincent,  it  is  to  a  modern  pipe- 
borne  water-supply  that  we  must  ascribe  the  prevention 
of  cholera,  and  no  doubt  also  the  probable  extinction  of 
yellow  fever.  Wells  were  done  away  with,  and  there- 
fore the  necessity  for  keeping  stagnant  or  roof-water 
ceased. 

Malaria. — This  disease  still  claims  a  very  considerable 
number  of  the  population.  It  is  chiefly  confined  to 
certain  districts,  as  Layou  and  Arno's  vale.  Several 
streams  pass  down  from  the  high  land  at  the  back  of 


172  HEALTH  PROGRESS  IN  ST  VINCENT 

Kingstown  to  reach  the  sea.  Their  mouths  are  liable  to 
become  blocked  by  the  foreshore,  and  in  addition  their 
beds  are  very  mieven  ;  as  a  result,  much  puddling  occurs. 
A  considerable  amount  of  malaria  is  attributed  to  them. 
The  island  is  also  intersected  by  numerous  streams, 
there  is  a  considerable  growth  of  trees,  and  there  exists 
some  low-lying  patches  of  swampland.  Some  of  the 
roadside  drains  are  also  shallow  and  weed-grown ;  they 
require  to  be  deepened  and  given  better  falls.  I  in- 
spected Paul's  Lot,  which  is  a  low-lying  swampy  piece 
of  land  and  requires  proper  drainage.  The  expenses 
which  would  be  incurred  to  carry  out  these  improve- 
ments would  be  counterbalanced  by  the  increase  in  the 
health  of  the  community. 

The  following  are  the  annual  number  of  cases  of 
malaria : — 

July  1905  to  March  1906  .         .         354  cases. 

April  1906  to  March  1907        .         .         525      „ 
April  1907  to  March  1908        .         .         281      „ 

As  in  the  other  islands,  so  in  St  Vincent,  entomological 
studies  have  been  taken  up  by  Mr  Paterson  of  the 
Imperial  Agricultural  Department. 

He  and  the  late  Dr  Branch  studied  the  question  of 
the  natural  enemies  of  mosquitos,  and  made  observa- 
tions showing  that  the  "  water-boatman  "  attacks  the 
larvae  of  mosquitos  by  sucking  them  dry. 

Other  Diseases : — 

Ankylostomiasis. — The  returns  show  a  very  con- 
siderable number  of  cases  of  ankylostomiasis  and 
anaemia. 


ST  LUCIA  173 

Tuberculosis  and  Syphilis  also  claim  a  very  large 
number  of  victims.  These  two  diseases  have  stepped 
in  and  increased,  v^hilst  the  water-spread  diseases  and 
yellow  fever  have  gone  steadily  out. 

Filariasis. — A  considerable  number  of  cases  are 
recorded  annually. 


CHAPTER   XIII 

HEALTH   PROGRESS   AND    ADMINISTRATION   IN   ST   LUCIA 

I  ARRIVED  in  St  Lucia  in  the  early  morning  of  the  9th 
April,  and  had  the  opportunity,  in  the   small  steamer 
in   which  I  travelled,  of  seeing  the  very  mountainous 
and  hilly  nature  of  the  island :   it  was  very  beautiful ; 
and    equally   pleasing    in    another    direction  was  the 
compact,   cleanly  appearance   of  the  prosperous   little 
coaling-port  of  Castries.     The  only   touch   of  sadness 
was  the   appearance  of  the  vast  collection  of  magnifi- 
cently constructed  military  quarters  lying  to  the  back  of 
the  town.     They  were  all  deserted,  and  it  was  most 
depressing  to  wander  through  block  after  block  and  to 
think  that  this  vast  expenditure  of  money  was  now  all 
wasted.     But  let  us  hope  that  they  may  yet  be  utilised. 
Of    course,   this    vast    preparation    for    the    garrisons 
recalled    the   time   when,   in   common   with  the   other 
islands,  yellow   fever  was  endemic  in   the  colony  and 
yearly  demanded  a  heavy  toll  of  the  garrison.     Yellow 
fever  was  prevalent  and  fatal  in  the  years  1818,  1822, 
1824,  and  1827.     In  1818  the  mortality  was  14*5  per 
cent. ;  in  1832,  308  per  cent. ;  in  1824  and  1827,  21  per 
cent. 

174 


THE  NEW  WATER-SUPPLY  175 

In  his  History  of  the  Black  Watch,  Archibald  Forbes 
has  described  the  mortality  in  the  campaign  of  1796, 
when  one  regiment  lost  800  men  in  one  year. 

Hunter  states  that  in  the  war  with  the  French  in  St 
Lucia,  5000  of  the   bravest  troops  in  the  world  took 
possession  of  the  island  with   httle  loss  from  fighting, 
but  at  the  end  of  twelve  months  scarcely  a  man  was  alive. 
To-day,  were  soldiers  quartered  in  them,  there  would 
in  all  probability  be  not  one  case ;  indeed,  the  soldiers 
would    be    in     far   more    bracing     and    health  -giving 
surroundings    than    in    the    old    country.     What    has 
banished   yellow  fever  from  the  Castries?     Again  the 
answer  is  the  same  as  in  the  case  of  the  adjacent  islands. 
The  introduction  in  1848  of  a  pipe-borne  water-supply 
laid  on  to  the  houses  and  to  standpipes  along  the  road. 
This   bedrock   measm^e  of    sanitary   reform    did   away 
to  a  considerable  extent  with  the   wells   and  barrels. 
With  the  diminution  of  the  wells,  water-carried  diseases, 
like   cholera,  disappeared  to  a  large  extent,  and   with 
the  lessening  of  the  number  of  water  receptacles,  the 
breeding  places  of  the  Stegomyia  were  also  reduced,  and 
the  chance  of  spreading  the  infection  of  yellow  fever 
greatly  diminished.     In  spite,  however,  of  the  modern 
pipe   supply,  there   persisted   a  very  large  number   of 
barrels  and  especially  numbers  of  the  old  type — French 
and  Spanish  olive  jars,  and; innumerable  odds  and  ends 
which  could  hold  water ;  there  were  also  a  few  concrete 
cisterns  and  iron  tanks.     From  1905  a  raid  was  com- 
menced  on  these   receptacles,  and  when    I   made   my 
house-to-house   inspection  this  year,  I   found  that  the 
large  jars  had  for  the  most  part  been  inverted,  so  that 


176  HEALTH  PROGRESS  IN  ST  LUCIA 

they  could  not  hold  water,  or  that  they  were  placed 
under  cover  so  that  the  rain  could  not  get  to  them. 
Eeceptacles  which  could  not  be  readily  removed  as 
cisterns  were  screened.  The  barrels  still  remaining  are, 
I  beheve,  also  screened.  A  few  wells  still  persist,  which 
no  doubt  will  soon  be  got  rid  of. 

Public  Health  Acts,  Ordinances,  and  Regulations. — 
In  1874  an  Ordinance  was  made  to  secm-e  the  health  of 
the  colony.  This  Act  dealt  with  the  appointment  of  the 
Board  of  Health;  the  making  of  sanitary  regulations; 
the  power  of  inspection ;  and  the  infliction  of  penalties. 
In  1881  a  special  Yaws  Ordinance  was  introduced. 

In  1902,  regulations  were  made  under  the  1874 
Ordinance  by  the  Board  of  Health.  These  dealt  with 
the  appointment  of  inspectors  of  nuisances,  the  cleansing 
of  houses  and  yards,  and  regulations  dealing  with  towns 
and  villages. 

In  1903  a  special  Ordinance,  entitled  the  "  Medical 
Officers'  Ordinance,"  was  made  to  amend  the  law  with 
respect  to  medical  officers.  The  colony  was  divided 
into  medical  districts,  of  which  there  are  now  six ;  the 
duties  of  medical  officers  were  also  proscribed. 

In  1907,  additional  regulations  were  formed  to  deal 
with  waste  and  stagnant  water,  and  all  water  receptacles, 
making  it  a  nuisance  to  keep  any  breeding  grounds  for 
mosquitos  unless  screened.  These  regulations  also 
proscribed  the  procedure  in  regard  to  yellow  fever  of  an 
up-to-date  character.  In  1908,  further  regulations 
were  issued  deaHng  with  contacts,  isolation,  sm-veillance, 
in  connection  with  plague,  cholera,  smallpox,  and 
yellow  fever. 


ANTIMOSQUITO  MEASURES  177 

Mosquito  Destruction. 

The  following  useful  notice  has  been  issued  to  house- 
holders in  St  Lucia,  July  1909  : — 

1.  In  the  general  interest  of  the  public  health,  and 
particularly  to  prevent  the  introduction  and  spread  of 
yellow  fever,  vrhich  would  most  seriously  affect  the 
trade  of  the  island,  every  householder  is  invited  to 
co-operate  with  the  health  authorities  in  the  destruction 
of  mosquitos. 

2.  It  is  by  mosquitos  that  both  yellow  fever  and  the 
ordinary  malarial  fever  are  carried  and  spread. 

3.  Mosquitos  can  only  breed  in  stagnant  water ; 
therefore  you  are  requested  to  see  that — 

(a)  Any  tanks  or  jars  or  other  water  receptacles  in 
your  yard  are  screened  according  to  the  Board 
of  Health  regulations,  to  prevent  mosquitos 
getting  into  the  water  to  breed. 

N.B. — The  health  authorities  mil  be  prepared  to  examine 

firemises  and  give  advice  as  to  the  proper  way  of  screening,  etc. 
n  Castries  a  specimen  of  such  screening  can  be  seen  at  the 
police  station. 

{h)  All  wells  are  filled  up. 

N.B. — Well-water  in  Castries  is  most  unwholesome. 

(c)  None  of  the  following  articles  are  kept  lying 
about  your  yards  or  lots  : — 

i,  bottles  :  whole  or  broken, 

ii.  tins, 

iii.  broken  pieces  of  earthenware, 

iv.  coco-nuts, 

V.  calabashes, 

or  any  other  thing  capable  of  holding  water. 

{d)  All  hollows  in  the  ground  about  your  yards 
or  adjacent  premises  are  filled  up  to  the  level, 
so  that  water  may  not  collect  in  them. 

M 


178  HEALTH  PROGRESS  IN  ST  LUCIA 

(6^)  Water  kept  in — 

i.  washing-tubs, 
ii.  flower  vases, 
iii.  chickens'  drinking-vessels, 

is  changed  very  frequently  and  the  vessels  kept 
free  from  moss,  because  the  green  moss  found  in 
such  vessels  harbours  the  mosquito  larvae  and 
keeps  them  alive  while  the  water  is  being 
changed. 

Issued  by  advice  of  the  Medical  Board. 

H.  A.  Smallwood, 

Acting  Colonial  Secretary. 

From  1906  the  Government  has,  in  fact,  taken 
systematic  steps  to  diminish  the  mosquito  nuisance, 
and  they  have  reaped  the  benefit,  as  we  shall  see. 

I  examined  the  inspection  book  of  one  of  the  sanitary 
inspectors.  It  testified  to  the  care  with  which  the  yards  of 
the  inhabitants  of  Castries  were  examined  for  the  presence 
of  water  receptacles,  rubbish,  and  especially  larvae. 

The  book  shows  that  at  first  the  inhabitants  were 
cautioned  against  the  dangers  of  stagnant  water  and 
harbouring  larvae.     Finally,  summonses  were  obtained. 

After  regulations  were  passed  making  it  an  ofience 
to  breed  larvae,  the  following  prosecutions  took  place  : — 

Year  1907  .  .  .  .13 

„     1908         .  .  .  .57 

„     1909         .  .  .  .28 

The  moving  force  which  more  than  anything  else  led 
to  the  health  security  of  St  Lucia,  was  the  active  stimulus 
of  the  late  Administrator,  Mr  Philip  C.  Cork.  I  had 
in  1905  the  privilege  of  working  with  Mr  Cork,  when 


A  USEFUL  MEASURE  179 

he  was  acting  as  Administrator  in  British  Honduras, 
during  the  yellow  fever  outbreak  in  that  colony.  The 
line  of  action  which  he  took  when  he  subsequently 
arrived  in  1906  in  St  Lucia  was  characteristic.  He 
issued  a  memorandum  to  medical  officers  in  the  island, 
calling  for  returns,  showing  the  number  and  description 
of  the  mosquito -borne  diseases  (for  the  previous  twelve 
months). 

The  information  elicited,  although  meagre,  was 
exceedingly  interesting  (see  Appendix).  In  the  first 
place,  it  drew  the  attention  of  medical  officers  to  the 
importance  and  significance  of  these  diseases,  and 
showed  that  the  administrator  was  fully  alive  to  the 
necessity  of  action.  In  the  second  place,  it  showed  to 
what  extent  the  medical  officers  had  kept  in  touch  with 
modern  developments  in  epidemiology  and  mosquito- 
borne  diseases.  Thirdly,  it  demonstrated  where  weak 
spots  existed  in  sanitary  administration  in  respect  of 
these  important  diseases,  and  where  in  consequence  the 
medical  machinery  required  augmentation.  If  this 
example  were  more  often  followed,  there  is  no  question 
in  my  mind  that  sanitary  administration  would  be 
greatly  strengthened  and  sickness  and  death-rates 
lowered. 

Another  circular  was  issued  to  the  medical  officers, 

as  follows : — 

Government  Office, 

Vlth  June  1909. 

Sir, — Referring  to  the  circular  from  this  office  dated 
21st  March  1907,  forwarding  for  your  information  and 
guidance  copy  of  additional  Regulations,  framed  by  the 
Board  of  Health  under  the  Public  Health  Ordinance, 


180  HEALTH  PROGRESS  IN  ST  LUCIA 

1874,  I  have  the  honour  to  invite  your  attention  to  the 
2nd  paragraph  of  that  circular,  and  shall  be  glad  to 
hear  from  you  that,  in  accordance  with  the  instructions 
contained  therein,  you  have  satisfied  yourself  that  the 
inspectors  of  nuisances  in  your  district  fully  understand 
the  duties  required  of  them  under  the  regulations,  and 
that  they  are  effectually  carrying  them  out. 

2.  I  shall  be  pleased  also  to  receive  a  report  from 
you  on  the  results  of  any  experiments  that  you  may 
have  made  for  destroying  mosquito  larvse  in  tanks  and 
barrels  by  the  use  of  small  fish,  as  suggested  by  Mr 
Cork. — I  have,  etc., 

E.  D.  Laborde. 


Stegomyia  Survey. — In  company  with  Dr  A.  King,  I 
visited  on  11th  and  12th  April,  93  houses  and  yards 
in  different  quarters  of  the  town,  including  those  of  the 
poorest  classes,  and  those  of  the  poor  and  better-class 
tradesmen. 

In  a  considerable  proportion  of  these  houses  there 
were  standpipes  in  the  yards,  and  if  not,  near  at  hand, 
in  the  roads ;  in  consequence,  there  is  no  necessity  for 
the  long  storage  of  water. 

The  water  receptacles  consist  of  large  jars,  very  few 
rain-water  barrels,  but  tubs  for  washing  clothes  are 
numerous.  There  are  also  large  tanks  for  storing  rain- 
water, and  a  few  wells  and  concrete  baths  and 
odd  receptacles.  Odd  receptacles  are,  however,  not 
numerous.  The  large  tanks  are  usually  screened 
with  wire-gauze,  and  the  jars  have  for  the  most  part 
been  removed  or  placed  mouth  downwards,  so  as  not 
to  collect  water.     It  is  obvious,  from  the  appearance  of 


K  .  _ 

K"      ■    ■  '. 

:\.^-     ^ 

HISTORY  OF  YELLOW  FEVER  181 

the  yards,  that  householders  have  been  warned  of  the 
danger  of  keeping  stagnant  water;  nevertheless,  as 
showing  the  importance  of  constant  vigilance,  I  found 
numerous  breeding  places  in  the  yards,  but  all  sources 
could  be  readily  got  rid  of. 

I  examined — 


4  barrels. 
85  washtubs. 
57  jars. 


36  kerosene  tins. 
96  buckets. 
1  well. 


Larvae  were  found  28  times  in  the  93  houses. 

History  of  Yellow  Fever  in  St  Lucia. — As  I  have  stated 
previously,  we  know  that  yellow  fever  formerly  regularly 
visited  the  island.  Thus,  in  1839,  we  read  that  yellow 
fever  attacked  the  troops  at  Morne  Fortune  from 
August  to  September,  and  that  out  of  1 34  white  troops, 
93  were  attacked,  and  20  died.  The  inhabitants, 
however,  suffered  still  more  severely,  and  the  epidemic 
commenced  earlier  amongst  them,  in  July.  It  is  stated 
that  the  disease  ceased  on  the  occurrence  of  the 
boisterous  weather  and  heavy  rains.  Some  cases  were, 
however,  recorded  on  Pigeon  Island  in  October.  An 
epidemic  is  also  recorded  in  1842.  In  1901,  yellow 
fever  is  stated  to  have  occurred  on  the  Morne  Fortune 
and  to  have  been  due  to  the  excavations  for  the  railway 
then  in  progress.  Since  1904 — that  is,  when  the  present 
principal  medical  officer,  Dr  King,  arrived  in  St  Lucia 
— no  case  has  been  recorded. 

During  the  period,  however,  there  was  very  consider- 
able risk  of  imported  cases  from  either  Martinique, 
Trinidad,  or  Barbados.    Dr  King  attributes  the  immunity 


182  HEALTH  PROGRESS  IN  ST  LUCIA 

of  the  island  to  rigid  inspection  of  ships  arriving  from 
infected  ports,  both  as  regards  the  passengers  and  crew, 
and  to  ascertaining  whether  all  Stegomyia  had  been 
killed  on  departure  of  a  ship  from  an  infected  port — 
in  other  words,  whether  fumigation  had  been  efficiently 
carried  out.  The  port  of  the  island  is  Castries,  but  on 
the  north  of  the  island  at  points  nearest  Martinique,  no 
doubt  the  arrival  of  small  boats  does  occur.  In  time  of 
danger  a  most  careful  watch  is  kept  upon  this  part  of 
the  coast.  In  any  case,  even  if  a  mild  case  had  passed 
in,  no  other  cases  have  occurred  in  the  island  during 
the  very  severe  epidemic  in  Martinique.  This  is 
attributed  to  the  great  additional  safeguard  of  having 
enforced  the  antilarval  measures  previously  alluded  to. 
We  have  already  noted  how  two  of  the  Windward 
Islands,  Grenada  and  St  Vincent,  had  a  few  cases  each 
as  the  result  of  importation.  Owing  to  the  precautions 
taken  in  each  of  these  islands,  the  disease  did  not 
spread.  In  St  Lucia,  the  third  island  of  the  Windward 
group,  and  within  only  a  few  miles  of  Martinique  by 
boat,  where  there  was  a  very  severe  epidemic,  and  in 
constant  communication  with  Barbados  and  Trinidad, 
where  also  there  was  yellow  fever,  not  one  case  of 
yellow  fever  occurred.  In  my  opinion  the  adminis- 
trative and  health  authorities  are  to  be  heartily 
congratulated  for  having  had  such  a  good  sanitary 
organisation.  Castries  is  a  growing  coaling  port,  and 
had  yellow  fever  occurred,  it  meant  destruction  to  the 
principal  industry  of  the  port.  In  this  year  (1909), 
whilst  yellow  fever  was  present  in  three  of  the  West 
Indian     islands,    St    Lucia    escaped    altogether,    and 


A  LESSON  TO  BARBADOS  183 

Grenada  and  St  Vincent  easily  prevented  their 
few  imported  cases  from  infecting  their  respec- 
tive territories.  In  my  opinion,  no  more  striking 
example  is  needed  to  demonstrate  the  economy  of 
having  a  chief  medical  officer  of  health,  and  a  proper 
modern  medical  organisation.  These  three  islands 
have  saved  in  1909  more  than  the  cost  of  their  medical 
organisations  by  their  security  from  yellow  fever. 
Surely  Barbados  is  now  in  a  position  to  study  what 
these  organisations  are,  and  to  adopt  a  similar  system, 
and  so  avoid  in  future  the  disaster  of  1909. 

Quarantine  Administration. — It  was  especially  during 
my  stay  in  Castries  that  I  was  made  aware  of  how, 
with  the  best  intentions,  the  practical  good  which  the 
intercolonial  quarantine  laws  were  calculated  to  bring 
might  be  neutralised  or  even  turned  to  disaster  by  the 
want  of  organisation  of  one  of  the  contracting  parties. 

The  Administrator  of  St  Lucia,  who,  as  I  have  said 
before,  had  a  thorough  knowledge  of  yellow  fever 
prophylaxis  and  quarantine  administration  as  affecting 
it,  was  perpetually  harassed  by  anxiety  lest  yellow  fever 
should  enter  St  Lucia  from  Barbados.  For  this  anxiety 
he  had  most  reasonable  grounds.  For,  owing  to  the 
admitted  unfortunate  delay  in  making  a  diagnosis  of 
the  fever  cases  in  Barbados,  ships  were  arriving  in 
Castries  with  clean  bills  at  a  time  when  rumour  and 
subsequent  notification  clearly  showed  that  yellow  fever 
existed  in  the  island.  And  not  only  this,  but  Dr  King, 
who  made  his  usual  rigid  examinations  of  the  ships, 
reported  to  Mr  Cork  that  fumigation  had  not  been 
completely  carried  out  in  Bridgetown,  for  he  found  living 


184  HEALTH  PROGRESS  IN  ST  LUCIA 

Stegomyia  in  some  of  the  ships  examined.  This,  of 
course,  is  as  serious  as  finding  cases  of  the  fever  in  man 
during  the  infective  stage.  An  infected  Stegomyia  is  as 
dangerous  as  an  infected  man,  and  the  ansvs^er  given  by 
Barbados  to  Mr  Cork's  anxious  enquiries  about  these 
matters  were,  in  my  opinion,  not  calculated  to  relieve 
his  natural  anxiety.  As  I  have  pointed  out  before, 
for  producing  this  state  of  alarm  in  a  friendly  and 
sister  colony,  Barbados  is,  in  my  opinion,  alone  to 
blame,  for  its  lack  of  proper  medical  organisation.  It 
is,  therefore,  incumbent  upon  Barbados,  in  the  interests 
not  only  of  its  own  trade,  but  of  that  of  the  sister 
colonies,  and  the  efficient  working  of  that  common-sense 
measure,  namely,  the  Inter-colonial  Quarantine  Act,  to 
recast  its  medical  organisation  and  appoint  an  efficient 
head. 

Quarantine  Station. — I  visited,  with  Dr  King,  the 
quarantine  station.     It  is  excellently  arranged. 

Other  Diseases  in  St  Lucia. — Annual  medical  reports 
are  published,  showing  what  the  hospitals  and  dis- 
pensaries are  doing,  so  that  the  enquirer  and  student 
can  readily  see  what  are  the  diseases  which  are  most 
prevalent,  and  thus  be  able  to  better  advise  on  the  best 
method  of  preventing  them. 

Amongst  the  chief  diseases  are  :  Malaria,  intestinal 
parasites,  ankylostomiasis,  yaws. 

Malaria. — The  island  is  volcanic  in  origin.  It  is 
very  mountainous ;  from  a  central  ridge  or  backbone 
numerous  streams  run  down  to  the  coast,  numerous 
very  fertile  valleys  starting  from  the  ridge,  spread  out 
and  become  flat  towards  the  coast ;  these  valleys,  being 


MALARIA  185 

well  supplied  by  streams  from  the  higher  ground, 
become  in  the  low-lying  parts  swampy,  the  soil  consists 
of  alluvial  mould  and  clay,  and  tends  to  hold  up  water. 
Sugar  is  cultivated  in  these  valleys,  and  malaria  is 
common  in  the  wet  season. 

I  visited  some  marshy  low-lying  spots  in  the  neigh- 
bourhood of  Castries,  which  it  is  proposed  to  drain, 
and  in  my  opinion  the  health  conditions  would  be 
greatly  improved  if  this  was  carried  out,  especially  as 
there  exists  no  insuperable  difficulty  in  carrying  out 
the  necessary  drainage  operations.  Owing  to  the 
prevalence  of  yaws  in  1881,  a  Yaws  Prevention 
Ordinance  was  made,  and  in  1907  a  further  Ordinance 
to  cement  it  in  certain  particulars  was  passed. 

Ankylostomiasis. — To  prevent  this  disease  from 
spreading,  public  opinion  was  being  educated  by  means 
of  leaflets,  setting  forth  the  simple  methods  of  preven- 
tion (see  Appendix). 

The  history  of  the  sanitary  progress  of  St  Lucia 
would  be  incomplete  without  reference  to  the  excellent 
work  accomplished  by  Major  Hodder.  This  observer 
has  given  a  most  excellent  account  of  the  drainage  and 
other  works  carried  out  in  1902-3  with  the  object  of 
destroying  mosquitos  in  St  Lucia.  The  Eoyal  Army 
Medical  Corps  and  the  Royal  Engineers  combined  to 
get  rid  of  the  pests  by  draining  swamps,  constructing 
new  drains,  and  clearing  bush.  The  Town  Board  of 
Castries  had  also  from  1890  to  1900  undertaken 
drainage  operations  and  had  introduced  the  new  water- 
supply  mentioned  to  begin  with.  In  Major  Hodder's 
opinion,  all  these  works  had  contributed   to   diminish 


186  HEALTH  PROGRESS  IN  ST  LUCIA 

malaria  in  Castries.  Major  Hodder  describes  the 
works  which  he  undertook  at  Vigie,  the  Morne,  and  La 
Toe,  at  a  total  cost  of  £3985,  or  an  annual  expenditure 
of  £1782.  The  figures  which  he  gives  are  of  very 
practical  value. 


CHAPTER  Xiy 

HEALTH    PROGRESS   AND   ADMINISTRATION   IN   TRINIDAD 

I  ARRIVED  in  Trinidad  on  3rd  May  1909.  It  is  a  large 
island,  with  some  336,769  inhabitants  ;  it  is  very  fertile, 
and  is  covered  with  vegetation ;  cocoa  and  cane  are 
the  staples,  and  rubber  is  now  being  largely  cultivated, 
and  cotton  is  beginning  to  be  grown  in  Tobago.  The 
island  is  hilly,  and  there  are  several  rivers. 

On  landing  in  Port  of  Spain,  I  experienced  the  same 
feelings  that  I  did  in  landing  at  the  other  islands. 
Here  was  Port  of  Spain,  in  every  sense  an  up-to-date 
and  well-found  city,  a  city  which  is  sometimes  spoken  of 
as  the  Liverpool  of  the  West  Indies.  There  was  no 
epidemic  passing  through  it,  nor  indeed  was  there 
any  abnormal  mortality.  But  what  was  the  condition 
in  the  early  part  of  the  nineteenth  century  ?  We  read 
that  the  mortality  of  our  troops  from  yellow  fever 
alone  was  30  per  cent,  in  the  year  1818,  and  in  1828  it 
was  13  per  cent.,  and  in  the  six  years  from  1820  to  1825 
it  was  on  an  average  of  3 '2  per  cent.  We  can  say  that 
in  those  days  yellow  fever  was  endemic  and  always 
present,  and  so,  we  may  be  sure,  were  all  the  other  West 
Indian  fevers.     In  the  adjacent  island  of  Tobago,  the 

187 


188  HEALTH  PROGRESS  IN  TRINIDAD 

mortality  in  1818  was  13  per  cent,  amongst  the  white 
troops ;  in  1819  it  was  18  per  cent.,  and  in  the  year 
1820  as  high  as  80  per  cent.  In  1821  it  was  25  per 
cent.  Pigmies  Hke  these  show  that  not  only  was  yellow 
fever  endemic,  but  that  new  arrivals  were,  as  in  all  the 
other  islands,  sure  to  get  it.  And  again  we  ask  the 
question  :  What  has  brought  about  the  almost  complete 
cessation  of  yellow  fever  ?  The  answer  is  the  same  as 
that  given  in  the  case  of  all  progressive  cities  in  the 
yellow  fever  zone — namely,  the  introduction  of  a  pipe- 
borne  water-supply.  This  was  introduced  in  1851. 
Also,  no  doubt  the  improvements  in  building  construc- 
tion, proper  drainage,  and  the  cleansing  of  backyards — 
the  conditions,  in  fact,  which  do  away  with  the  necessity 
for  the  storage  of  water  in  barrels  and  odd  receptacles, 
and  which  prevent  the  formationjof  puddles — contributed 
in  no  small  measure  to  the  present-day  security. 

The  Water-supply. — The  pipe  service  was  introduced 
in  1851,  since  which  date  great  extension  of  the  area 
supplied  has  taken  place,  and  further  extensive  improve- 
ments are  now  contemplated.  To  the  new  water  system 
we  must  then  ascribe,  as  in  each  of  the  other  islands, 
the  death  of  yellow  fever,  and  no  doubt  also  the  marked 
diminution  of  all  those  diseases  due  to  the  consumption 
of  polluted  water. 

If  up  to  the  year  1825  yellow  fever  was  the  rule 
rather  than  the  exception,  what  outbreaks  have  been 
recorded  in  the  latter  half  of  the  nineteenth  century  ? 
Outbreaks  are  recorded  in  Trinidad  in  the  years  1889, 
1891,  and  1894,  and  the  last  small  outbreak,  which  was 
comparatively  recent,  was  in  1907.     These  dates  show  a 


PXAN     OF  \-^'' 


Port  of  <5'pf>iN    Scivcfiage  Wobks         q 


Cne  a.?y:a.  shaded  joinJe, 


FIG.   25. — PLAN   OF  POET   OF   SPAIN   AND   SUBUEBS. 


[Face  xiagc  188. 


HISTORY  OF  OUTBREAK  189 

certain  amount  of  the  periodicity  noted  by  the  older 
writers — in  this  case  a  recurrence  after  intervals  of  twelve 
or  thirteen  years.  As  I  have  stated  elsewhere,  this 
periodicity  may  be  related  to  the  immunising  effect  of  each 
epidemic  upon  the  population :  non-immunes  are  born 
in  the  intervals,  and  new  arrivals  come  from  other 
countries ;  then,  given  the  importation  of  yellow  fever, 
the  non-immunes  are  picked  out  by  the  disease.  But 
after  an  epidemic  a  large  immune  population  is  left 
in  possession,  and  naturally  no  cases  occur  amongst 
them  until  the  non-immunes  have  had  time  to  collect 
again. 

History  and  Duration  of  the  recent  Outbreak. — From 
the  end  of  January  1907  to  the  end  of  March  in  the 
same  year,  five  cases  of  yellow  fever  occurred ;  all  those 
attacked  were  new  arrivals,  the  type  of  fever  was  severe, 
and  four  out  of  the  five  died.  Looking  at  these  cases  in 
the  light  of  what  we  know  about  yellow  fever,  gained 
both  from  the  experience  of  past  epidemics  and  of  recent 
ones,  I  can  come  to  no  other  conclusion  than  that  there 
was  in  the  Port  of  Spain  an  area  in  which  there  was  a 
considerable  number  of  infected  Stegomyia;  and  this 
would  indicate  that  there  had  been  in  that  area  unrecog- 
nised cases  of  yellow  fever.  As  in  the  case  of  Barbados, 
the  outbreak  of  yellow  fever  amongst  the  newly  arrived 
gives  the  impression  of  a  "  bolt  from  the  blue."  In  reality 
it  is  nothing  of  the  kind :  the  disease  was  there 
smouldering  for  a  considerable  time  unobserved,  but 
nevertheless  able  to  communicate  the  virus  to  the 
Stegomyia,  which  in  its  turn  infected  the  sensitive  new 
arrival  with  the  malignity  typical  of  this  disease ;  then 


190 


HEALTH  PROGRESS  IN  TRINIDAD 


the  disease  became  patent  to  all.  This  is  the  usual 
history  throughout  the  yellow  fever  zone.  The  first 
mild  cases  amongst  the  inhabitants  are  not  recognised  ; 
the  new  arrival,  as  in  the  days  of  Blair,  becomes,  when 
infected,  the  first  signal  that  anything  is  wrong.  Cases 
continued  to  recur  from  March  onwards  to  the  end  of 
August  of  the  same  year,  1907,  by  which  time  there  had 
been  38  cases.  Then  a  new  case  was  found  in  the 
town  of  San  Fernando  on  1st  November,  and  further 
cases  developed,  until  a  total  of  47  was  reached  on 
1st  March  1908.  That  is  to  say,  the  epidemic  lasted 
fifteen  months,  and  there  were  altogether  47  cases,  28  of 
which  were  fatal.  This  represents  a  high  percentage 
mortality. 


Return  of  Number  of  Cases  of  Yellow  Fever  Notified,  and 
the  Number  of  Deaths  in  the  Colony  and  in  Port  of 
Spain,  for  the  years  1907,  1908,  and  1909. 


Tear. 

No.  of  Cases 

treated 
in  the  Colony. 

No.  of  Deaths 
in  the  Colony. 

No.  of  Cases 

treated 

in  Port  of  Spain. 

No.  of  Deaths 

in 
Port  of  Spain. 

M. 

F. 

T. 

M. 

F. 

T. 

M. 

F. 

T. 

M. 

F. 

T. 

1907  . 
1908. 
1909. 

31 
3 

8 

7 

39 
10 

18 
2 

3 
6 

21 

8 

24 
1 
1 

7 
7 

31 
8 
1 

17 
1 

1 

1 
6 

18 
7 

1 

The  following  statement  details  in  tabular  form 
some  interesting  features  of  the  incidence,  etc.,  of  the 
disease : — 


MORTALITY 


191 


Table  showing  Sex,  Age,  and  Race  Distribution  of  Cases  of 
Yellow  Fever  in  1907-8,  with  Number  of  Deaths, 
Death-rates,  etc. 


Total 

No. 

of 

Cases. 

Sex. 

Average 
Age. 

Race. 

No.  of 
Deaths. 

No.  of 
Eecoveries. 

Death, 
rate. 
Gross. 

Death-rate 
per  cent, 
of  Attacks. 

M. 

F. 

M. 

F. 

WMte. 

Col- 
oured. 

Black. 

M. 

F. 

M. 

F. 

M.        F. 

47 

32 

15 

25-9 

23-46 

40 

5 

2 

18 

10 

14 

5 

59-57 

56-2  66-3 

More  than  twice  as  many  males  as  females  attacked, 
but  percentage  of  deaths  amongst  females  attacked 
was  greater  than  amongst  males.  Ten  of  those  attacked 
were  natives  of  the  West  Indies,  one  was  an  indentured 
East  Indian  immigrant,  the  remainder  had  resided  in 
the  West  Indies  for  periods  varying  from  four  days  to 
thirteen  years. 

The  Origin  of  the  Outbreak — It  is  exceedingly 
interesting  to  note  that  this  epidemic  partook  of  the 
usual  character,  namely,  the  "  bolt  from  the  blue  "  type. 
There  was  a  distinct  feeling  amongst  the  medical 
profession  that  the  origin  of  the  disease  might  be 
miasmatic — that  is,  that  there  were  local  predisposing 
causes.  In  other  words,  that  there  was  something  in 
Trinidad  which,  apart  from  importation,  could  give  rise 
to  the  disease.  This  is,  as  we  have  seen,  the  revival  of 
the  ancient  and  long-buried  doctrine  of  local  miasmatic 
origin.  It  is  the  invocation  of  the  miraculous  to  explain 
an  outbreak  which,  to  my  mind,  has  a  perfectly  rational 
and  easy  explanation.  A  glance  at  the  map  of  Trinidad 
shows  at  once  the  proximity  of  Trinidad  to  Venezuela. 


192  HEALTH  PROGRESS  IN  TRINIDAD 

The  former  is  placed  at  the  mouth  of  the  Orinoco. 
There  is,  therefore,  a  large  trade  and  intercom'se  with 
Venezuela,  and  there  are  many  Venezuelans  and 
relations  of  Venezuelans  in  Trinidad.  Moreover,  the 
latter  place  is  peaceful  and  prosperous,  while  the  former 
territory,  until  quite  recently,  was  the  reverse.  There 
is,  therefore,  an  inset  of  traffic  from  Venezuela  to 
Trinidad.  If  we  enquire  what  are  the  health  conditions 
obtaining  in  Venezuela,  we  learn  that  they  have  been 
very  bad^ — as  bad  as  could  be ;  there  has  been  practically 
no  health  administration.  Yellow  fever,  it  is  reasonable 
to  suppose,  is  endemic  in  that  country,  and  systematic 
anti-yellow  fever  measures  have  never  been  undertaken. 
We  learn  from  our  consular  representatives  that 
yellow  fever  is  practically  always  present  in  La  Guayra 
and  Caracas,  and  in  1907  there  were  epidemics  at 
Ciudad  Bolivar  —  a  trading  port  on  the  Orinoco 
having  a  constant  communication  with  Port  of  Spain. 
There  were  some  forty  to  fifty  reported  cases  in  1907,  and 
some  150  in  1908.  These  of  course  only  represent  the 
cases  of  fever  amongst  the  better-class  people ;  in  all 
probability  the  cases  amongst  the  poor  and  very  poor 
were  never  reported,  and  the  epidemic  might  therefore 
have  been  a  very  large  one.  U.S.  Consul  Moffat, 
reporting  to  Washington,  11th  May  1907,  from  La 
Guayra,  stated :  "  Yellow  fever  and  smallpox  are  at 
all  time  more  or  less  prevalent  here."  Ciudad  Bolivar 
is  only  forty-eight  hours  distant  by  steamer  from  Port  of 
Spain.  In  1909,  forty-one  ships  arrived  from  Ciudad ; 
they  were  all  cattle-boats  and  regular  traders,  with  one 
exception ;  they  all  brought  passengers.     Being  for  the 


ORIGIN  OF  THE  OUTBREAK  193 

most  part  cattle-boats,  they  have  to  remain  alongside 
the  wharf  at  Ciudad  for  some  time  to  load  up.  At 
all  times,  cattle-boats,  unless  under  the  strictest  super- 
vision, are  a  source  of  danger.  Nevertheless,  we  learn 
that  this  form  of  craft  was  treated  like  all  others — 
strictly  in  accordance  with  quarantine  regulations — and 
as  the  Venezuelan  authorities  no  doubt  rarely  admitted 
under  Castro's  regime  that  they  ever  had  yellow  fever 
or  plague,  it  is  probable  that  these  ships  carried  clean 
bills  and  were  not  fumigated  at  Port  of  Spain,  nor 
the  passengers  and  crew  kept  under  observation  in 
a  quarantine  station,  or  under  surveillance.  In  my 
opinion,  we  do  not  want  to  invoke  the  long-buried 
tradition  of  miasms  to  account  for  infection,  when  there 
is  such  an  obvious  som'ce  as  Venezuela,  and  one  which 
has  probably  been  ever  present;  and  the  reason  why 
Trinidad  has  not  been  overrun  with  yellow  fever  and 
plague  for  years  past,  has  been  because,  as  we  will 
show,  the  local  sanitary  organisation  has  been  really 
excellent,  and  the  Stegomyia  has  been  kept  under. 
Otherwise,  I  am  convinced  that  yellow  fever  would  be 
as  endemic  in  Trinidad  to-day  as  it  is  in  Venezuela  or 
in  ports  on  the  Amazon.  As  showing  how  Central 
American  countries  treat  yellow  fever  and  smallpox,  the 
following  statement  is  of  interest : — 

Report  of  the  Prevalence  of  Yellow  Fever  iii  Central 

America. 

British  Consulate, 
Guayaquil,  Ecuadoe,  November  10,  1906. 

Sir, — I  have  the  honour  to  report,  in  pursuance  of 
instructions  contained   in  Commercial  Circular  of  the 

N 


194  HEALTH  PROGRESS  IN  TRINIDAD 

Foreign  Office,  No.  26350,  dated  31st  August  last, 
that  various  cases  of  yellow  fever  exist  at  this  port. 
There  are  ten  cases  under  treatment  in  the  Yellow 
Fever  Lazarette,  besides  others  in  private  houses 
(numbers  not  ascertainable).  From  20th  October  last 
to  date,  four  deaths  have  occurred  from  this  fever. 

Smallpox  is  also  prevalent  here  on  a  large  scale. 
The  number  of  cases  cannot  be  ascertained,  but  there 
have  been  eighteen  deaths  in  the  same  period  (since 
20th  October). 

No  measures  whatever  have  been  taken  by  the 
Government  or  municipal  authorities  to  deal  with 
these  serious  infectious  maladies. 

Alfred  Cartwright. 

The  Colonial  Secretary, 
Trinidad. 

In  addition  to  Venezuela,  Port  of  Spain  has  over- 
sea relations  with  Brazil  and  the  Amazon,  Dutch 
Guiana,  Central  America,  and  Barbados. 

To  my  mind,  however,  the  evidence  points  to 
Venezuela,  and  in  this  connection  I  am  informed  by  Dr 
Prada  that  in  the  1894  epidemic  in  Trinidad  the  earliest 
cases  were  amongst  Italians  who  had  come  from 
Venezuela,  and  that  from  them  it  rapidly  spread. 

As  Venezuela  is  so  close  to  British  territory,  and  as 
it  is  the  country  which  commerce-paralysing  diseases 
are  most  likely  to  traverse,  I  have  made  special  enquiry 
into  the  health  conditions  obtaining  there,  and  Surgeon- 
General  Clare  has  furnished  me  with  the  following 
useful  information : — 

Health  Administration  in  Venezuela. — It  will  be 
understood  that  these  observations  were  made  in 
President  Castro's  time  of  office,  and  it  is  now  to  be 


YELLOW  FEVER  IN  VENEZUELA      195 

hoped  that  with  the  change  of  Government,  a  sanitary 
awakening  similar  to  that  which  has  passed  through 
Mexico  and  Brazil,  will  be  brought  about. 

Notification  of  infectious  diseases  are  not  compulsory. 
The  British  Minister  at  Caracas  says,  under  date  12th 
December  1907 : — 

I  have  the  honour  to  inform  Your  Excellency  that 
a  considerable  amount  of  smallpox  has  continued  to 
prevail  at  Caracas  up  to  the  present  date.  ...  In  reply 
to  Your  Excellency's  dispatch  of  the  3rd  instant,  which 
reaches  me  as  I  write,  I  would  explain  that  the  notifica- 
tion of  infectious  diseases  is  not  compulsory  in  this 
country,  and  that,  consequently,  the  authorities  are  not 
able,  even  were  they  anxious,  to  provide  accurate 
information.  In  point  of  fact,  their  attitude  is  the 
reverse  of  helpful. 

The  British  Vice-Consul  at  La  Guayra  says,  under 
date  4th  July  1907  :— 

No  sanitary  report  is  furnished  from  the  hospitals 
or  by  the  doctor  of  the  port.  One  is  therefore  obliged 
to  depend  merely  on  public  rumours  to  learn  when  there 
is  any  increase  in  the  sick  rate  of  the  town.  .  .  .  While 
on  this  subject,  it  might  be  well  to  state  that  although 
there  is  always  some  fever  in  La  Guayra  (and  indeed  all 
other  ports  of  Venezuela)  from  which  deaths  do  occur, 
it  is  not  at  all  certain  that  it  is  yellow  fever.  It  is  only 
given  that  name  in  the  rare  cases  in  which  foreigners 
are  attacked,  and  the  greater  number  of  these  cases  even 
are  not  fatal. 

July  Uh,  1907. — The  British  Vice-Consul  at  La 
Guayra  says : — 

There   is    no    means   of  obtaining  any   ofiicial  or 


196  HEALTH  PROGRESS  IN  TRINIDAD 

reliable    information    on    the   subject   of  the   diseases 
existing,  or  about  fresh  cases  which  may  occm*. 

The  British  Minister  at  Caracas  reports,  under  date 
7th  July  1908,  while  transmitting  a  copy  of  a  note  from 
the  Minister  of  Foreign  Affairs,  Venezuela,  stating  that 
plague  had  been  exterminated  in  the  port  of  LaGuayra  : — 

In  spite  of  this  official  announcement,  I  am  given 
to  understand  by  the  Vice- Consul  at  La  Guayra  that 
two  more  cases  have  occurred,  the  last  on  the  30th 
ultimo.  These  are  no  part  of  those  I  mentioned  in  my 
postscript  in  my  last  communication. 

The  Vice-Consul's  report  said  :  — 

As  regards  this  city,  I  hear  that  there  were  two 
cases  on  Sunday  last.  Certain  perfunctory  precautionary 
measures  are  being  taken.  ...  I  understand  that  the 
Government  of  Caracas  imposes  quarantine  on  arrivals 
from  Puerto  Cabello,  on  account  of  the  prevalence  of 
yellow  fever  in  that  port. 

In  a  private  communication  H.B.M.  Minister  at 
Caracas  says,  under  date  1st  December  1908  : — 

It  may  be  remembered  that  yellow  fever  is  more 
or  less  endemic  in  the  Maracaibo  district. 

July  1th,  1908. — British  Minister  at  Caracas  reports 
that  the  Government  of  CuraQoa  are  quarantining 
arrivals  from  Puerto  Cabello,  on  account  of  the  prevalence 
of  yellow  fever  in  that  port. 

Under  date,  Guayra,  20th  September  1908,  the 
British  Vice-Consul  says  : — 

The  sicknesses  in  Yaguarapero,  Yrapa,  and  Cristobal 


FEVERS  IN  VENEZUELA  197 

Colon  are  endemic  fevers;  but  I  must  inform  Your 
Excellency  that  the  ports  of  the  Republic  pertaining  to 
my  Consular  District  take  no  precautions  whatsoever 
to  prevent  contagion,  should  there  be  any  epidemic  in 
other  states  of  the  Eepublic. 

In  reporting  three  authenticated  cases  of  plague  at 
Caracas,  under  date  5th  June  1908,  the  British 
Minister  says : — 

No  official  communication  of  any  kind  has  been 
made  on  the  subject,  and  no  information  is  obtainable 
from  official  sources.  The  Press,  which  is  under 
Government  control,  has  not  alluded  to  the  matter. 
No  trains  have  as  yet  been  permitted  to  run  between 
Caracas  and  La  Guayra,  but  carts  are  permitted  to  convey 
goods  under  certain  restrictions.  Clandestine  com- 
munication is  constant.  The  fund  collected  for  prophy- 
lactic measures  is  exhausted  and  great  discontent  is 
prevalent  in  the  town.  A  few  days  ago  there  were 
some  incipient  attempts  at  riot  and  the  offices  of  the 
German  firm  of  Blohm  were  stoned.  .  .  .  The 
information  to  be  obtained  from  the  sanitary  authorities 
is  demonstrably  false. 

Under   date  4th   May   1908,   the  British  Minister 

says  : — 

No  credence  need  be  attached  to  the  "  official " 
figures  given  above.  There  is  reason  to  believe  that 
they  might  be  doubled  or  trebled  without  exceeding  the 
mark.  The  sanitary  cordon,  which  is  supposed  to 
isolate  La  Guayra,  continues  to  be  a  pure  farce. 

21st  April  1908. — Reporting  several  more  deaths 
from  the  mysterious  sickness,  which  afterwards  proved 
to  be  plague,  the  British  Minister  says  : — 


198  HEALTH  PROGRESS  IN  TRINIDAD 

The  Venezuelan  Government  has  at  last  had 
recourse  to  other  measures  than  the  imprisonment  of 
the  doctors  who  reported  it,  and  a  Presidential  Decree, 
dated  18th  April,  prohibits  all  communication  with  La 
Guayra  for  a  period  of  fifteen  days  .  .  .  the  difficulty 
of  obtaining  reliable  information  is  very  great.  ...  I 
understand  from  the  Vice-Consul  at  La  Guayra  that 
funerals  are  taking  place  secretly  and  at  night  .  .  . 
efforts  adopted  by  the  authorities  are  entirely  directed 
by  executive  officers  without  expert  medical  or  sanitary 
advice,  and  are  likely  to  prove  as  inefiicacious  as  they 
are  drastic  .  .  .  the  sanitary  cordon  is  a  farce. 
Fugitives  from  La  Gua}Ta  can  easily  reach  Caracas  on 
foot  by  the  mountain  paths,  and  the  number  so  arriving 
must  be  considerable. 

These  memoranda  conclusively  show  that  the 
sanitary  organisation  was  in  a  very  weak  state,  and  that 
no  reliance  could  be  placed  upon  any  health  report 
issued  from  Venezuela.  So  obviously  bad  was  the 
system  of  notification  that  the  British  Minister  at 
Caracas  sent  a  special  memorandum  on  the  subject  to 
the  Minister  of  Foreign  Affairs  in  Venezuela,  pointing 
out  the  great  disadvantage  of  the  system  to  commerce. 
In  December  1908,  Trinidad  was  asked  to  remove 
quarantine  restrictions  against  arrivals  from  Venezuela. 
The  Surgeon- General,  in  my  opinion,  replied  correctly 
when  he  pointed  out  that  as  they  had  no  really  trust- 
worthy information  of  the  health  conditions  obtaining 
in  Venezuela,  it  would  be  unwise  to  remove  restrictions. 
The  opinion  of  the  Surgeon-General  was  not,  however, 
followed,  and  quarantine  restrictions  were  removed. 
This  action,  in  my  opinion,  was  most  unwise.  For  until 
Venezuela  puts  its  house  in  order,  and  the  Trinidad  sani- 


HEALTH  OF  VENEZUELA  199 

tary  authority  has  positive  evidence  that  there  is  an 
efficient  sanitary  administration,  similar  to  that  existing 
in  Trinidad  itself,  it  appears  to  me  to  be  incumbent  upon 
Trinidad  to  most  carefully  supervise  all  arrivals  from 
Venezuela.  I  cannot  too  strongly  insist  upon  the  fact 
that  plague  is  passing  from  the  Pacific  side  of  the 
American  continent  to  the  Atlantic  side,  and  that  one 
great  highway  for  its  passage  is  through  Venezuela, 
where,  owing  to  lack  of  organisation  in  the  past,  the 
conditions  for  its  taking  root  and  spreading  are  present. 
From  Venezuela  the  plague  is  unquestionably  creeping 
in  its  eastward  course,  and  it  has  now  got  to  its  first 
barrier — that  is,  Trinidad ;  here,  thanks  to  a  very 
efficient  medical  organisation  and  sanitary  service,  it 
has  been  held  in  check.  This,  however,  places  a  very 
severe  strain  on  Trinidad,  and  in  order  to  lessen  it  as 
much  as  possible,  I  strongly  urge  the  careful  inspection 
of  all  ships  and  passengers  arriving  from  Venezuela. 

In  connection  with  a  more  stringent  supervision  of 
the  Venezuelan  traffic,  Mr  H.  B.  Walcott,  Collector  of 
Customs,  Trinidad,  suggested  a  line  of  action  similar  to 
that  adopted  with  success  in  British  Hondm^as — namely, 
the  insistence  of  weekly  reports  from  the  Consuls  in 
Venezuela,  the  examination  of  Venezuelan  ports  by 
English  medical  officers,  as  done  in  Guatemala  and 
in  Spanish  Honduras,  then  systematic  inspection  and 
fumigation  of  all  vessels  arriving  from  Venezuela,  as 
was  done  in  Belize.  La  Guayra  is  the  port  for  Caracas, 
and  Ciudad  Bolivar  is  the  large  port  on  the  Orinoco. 
From  both  places  steamships  come,  both  to  Port  of 
Spain   and    San    Fernando.     Moreover,   small    saihng 


200  HEALTH  PROGRESS  IN  TRINIDAD 

craft  of  from  5  to  10  tons,  which  ply  an  irregular  trade, 
also  pass  between  these  ports.  The  smaller  boats  may 
come  to  La  Brea  and  Mayaro. 

On  17th  May  1909,  I  visited  the  s.s.  Delta,  a 
stern-wheeler  used  in  the  cattle  and  passenger  trade 
between  ports  on  the  Orinoco  and  Port  of  Spain.  I 
examined  the  ship.  I  did  not  observe  any  mosquitos 
on  board,  but  it  would  be  very  easy  for  mosquitos  to 
gain  access  while  she  was  moored  alongside  at  Bolivar. 

The  following  memorandum  on  the  communication 
between  Trinidad,  Venezuela,  and  the  Orinoco  River 
has  been  kindly  furnished  me  by  the  Collector  of 
Customs,  10th  May  1909. 

The  number  of  vessels  entered  and  cleared  from  and 
to  Venezuela  and  the  Orinoco  during  the  year  ended 
31st  March  1908  was  as  follows  : — 

Entered.  Cleared. 

Sailing  vessels     .     1,413,     18,052  tons.  1,457,     18,377  tons 

Steamers     .         .        176,  124,258     „  242,  274,013     „ 

The  steam  communication  is  as  under  : — 

Orinoco  River  (Bolivar,  San  Felix,  and  other  points  on 
the  river)  to  Port  of  Spain.  One  steamer  fortnightly, 
and  occasional  steamers.  Time  taken,  thirty  to  thirty- 
six  hours. 

Venezuelan  coast  of  Paria  to  Port  of  Spain.  Occa- 
sional steamers,  guarda  costas,  and  launches.  Time 
taken,  six  to  thirty-six  hours. 

Northern  coast  of  Venezuela  (Carupano  and 
onwards)  to  Port  of  Spain.  French  Line,  one  monthly. 
Dutch  Line,  two  monthly,  Hamburg  American  Line, 
two  monthly,  and  occasional  steamers.  Time  taken, 
seven  to  ten  hours. 


COMMUNICATION  WITH  VENEZUELA  201 

The  communication  by  sailing  vessels  is  : — 

Venezuelan  coast  of  Paria  (usually  Maturin)  to  Port 
of  Spain.  One  ton  upwards,  average  one  a  day.  Time 
taken,  three  days. 

Venezuelan  coast  of  Paria,  Bolivar,  Maturin  to  San 
Fernando.  One  ton  upwards,  average  one  daily.  Two  to 
three  days. 

Orinoco  to  La  Brea,  Mayaro,  and  Cedros.  Open 
corials.  Time  taken,  three  days.  Nearest  point 
northern  coast  of  Venezuela,  Christobal  Colon,  and  other 
places  to  Monos.  Open  boats.  Average,  one  daily. 
Time  taken,  six  to  twelve  hours. 

As  I  mentioned  in  my  interim  report  to  the  Governor 
of  Trinidad,  in  my  opinion  it  would  be  most  desirable 
that  the  whole  services  of  a  medical  officer  should  be 
used  for  the  duties  of  quarantine  officer,  and  that  he 
or  an  assistant  medical  officer  should  from  time  to  time 
visit  towns  in  Venezuela,  so  as  to  make  a  personal 
investigation  of  the  health  conditions  obtaining  there. 

Difficulties  of  Diagnosis. — Just  as  difficulties  over  the 
question  of  diagnosis  occurred  in  Barbados,  and  have 
occurred  time  and  time  again  in  the  history  of  all  yellow 
fever  outbreaks,  so  in  Trinidad  there  were  difficulties ; 
and  these  difficulties,  as  in  the  case  of  Barbados,  led  to 
suspicions  on  the  part  of  adjacent  sister  colonies.  It 
will  be  recollected  that  Barbados  diagnosed  a  form  of 
gastric  influenza  accompanied  by  black  vomit — a  disease 
which  was,  in  all  probability,  yellow  fever.  In  Trinidad 
some  of  the  medical  men  and  Surgeon- General  Clare 
diagnosed  a  very  severe  form  of  malaria — a  typho- 
malaria — of  few  days'  duration,  very  fatal,  and  some- 
times, so  it  is  stated,  accompanied  by  vomiting.     It  is 


202  HEALTH  PROGRESS  IN  TRINIDAD 

now,  of  course,  of  very  little  use  to  speculate  as  to 
whether  this  typho-malaria  was  really  malaria  or  yellow 
fever  or  not.  I  mention  the  circumstances  here,  in  order 
to  emphasize  the  necessity  in  all  cases  where  there  is  a 
difficulty  of  diagnosis  in  respect  to  diseases  which  have 
important  administrative  consequences,  of  convening  a 
small  board  of  medical  experts  to  act  as  a  consultative 
body  with  the  Surgeon-General.  Wherever  one  goes  in 
the  West  Indies,  there  is  always  evidence  of  doubtful 
diagnosis,  and  in  consequence  plenty  of  interinsular 
incredulity — far  more  intercolonial  confidence  is  required 
to  work  the  quarantine  laws  to  their  best  advantage. 

Yellow  Fever  Prophylaxis  iri  Trinidad. — The  Surgeon- 
General  furnished  me  with  the  following  interesting 
memoranda  of  the  precautionary  measm-es  taken  : — 

Special  powers  were  secured  for  the  sanitary 
authority  by  regulations  made  by  the  Governor  in 
Executive  Council  on  •22nd  March  and  6th  April  1907, 
enabling  prompt  action  to  be  taken  with  a  view  to 
accurate  diagnosis  and  efficient  control  of  each  case  as 
it  occurred,  and  to  limit  the  spread  of  infection  ;  these 
regulations  were  amended  and  consolidated  on  the  16th 
January  1908,  and  very  active  measures  directed 
towards  improved  sanitary  conditions,  and  the  extensive 
destruction  of  mosquitos  were  in  operation  during  the 
prevalence  of  the  disease ;  there  can  be  no  doubt  these 
operations  were  successful  in  largely  controlling  the 
spread  of  yellow  fever  in  the  town,  but  so  many  appar- 
ently distinct  and  yet  potentially  active  foci  of  infection 
presented  themselves  at  intervals,  that  it  became  a 
matter  of  much  difficulty  to  exert  and  to  maintain  a 
restricting  influence  upon  the  progress  of  the  disease. 
In  this  connection  the  importance  of  individual  efforts 
in  co-operation  with  the  sanitary  authorities  can  scarcely 


PRECAUTIONARY  MEASURES  203 

be  over-estimated,  and  it  is  surprising,  and  a  matter  for 
regret,  that  persistent  practical  demonstrations  and 
instruction  by  the  sanitary  staff  appeared  to  arouse 
so  little  personal  interest  and  sustained  effort  towards 
the  protection  of  the  individual  and  the  community  from 
extension  of  the  disease. 

On  the  occurrence  of  the  first  case,  steps  were  at  once 
taken  for  screening  and  isolating  the  patient,  and  for 
fumigating  the  house  and  the  adjoining  premises,  and 
the  residents  in  the  immediate  neighbourhood  were 
kept  under  daily  observation. 

These  measures  were  carried  out  generally  with 
respect  to  subsequent  cases. 

The  staff  of  assistant  sanitary  inspectors  was 
augmented,  for  the  more  effectual  inspecting  and 
cleansing  of  yards  throughout  the  town. 

A  proposal  from  the  Acting  Inspector-General  of 
Constabulary  for  enlisting  the  services  of  the  police  in 
carrying  out  these  duties  was  gladly  accepted,  and  their 
co-operation  proved  of  great  assistance  in  the  work  of 
sanitation. 

It  was  evident  from  the  beginning  of  the  epidemic 
that  the  infection  was  spread  over  a  wide  area  in  Port 
of  Spain.  No  case,  however,  occurred  near  the  water- 
front, or  in  the  lower  half  of  the  town. 

It  is  to  be  regretted  that  it  has  not  been  found 
possible  to  arrive  at  any  satisfactory  conclusion  with 
regard  to  the  origin  of  the  epidemic.  Yellow  fever  is 
not  endemic  in  Trinidad.  It  is  remarkable  that 
epidemics  of  the  disease  (although  a  difference  of 
opinion  obtained  amongst  medical  men  as  to  its  nature) 
appear  to  have  occurred  at  intervals  of  about  twelve  to 
thirteen  years,  viz.  :  in  1869,  1881-82,  1893-94,  and  in 
1907. 

Trinidad  is  peculiarly  open  to  the  importation  of 
infectious  disease  from  the  neighbouring  mainland  of 
Venezuela,  which  presents  a  long  coastline  in  close 
proximity,  and  there  being  no    obligation  on  the  part 


204  HEALTH  PROGRESS  IN  TRINIDAD 

of  the  Venezuelan  authorities  to  notify  the  existence  of 
such  infectious  disease. 

(Up  to  the  end  of  June  there  have  been  twenty-four 
cases  notified,  with  eleven  deaths.  Later  cases  were 
generally  of  a  milder  type.  The  fact  that  not  more  than 
one  case  occurred  in  any  house,  would  afford  ground  for 
believing  that  the  preventive  measures  adopted  were 
effective.) 

As  evidence  of  the  activity  of  the  sanitary  service 
and  medical  administration,  I  quote  the  following 
extract  of  the  proceedings  of  the  Board  of  Health, 
(published  in  the  Port  of  Spain  Gazette,  4th  May 
1909)  :— 

The  acting  sanitary  inspector  reported  that  the 
regular  and  surprise  visits  had  been  paid  during  the 
month  of  April,  and  of  471  orders  served,  351  were 
complied  with.  Three  cases  of  typhoid  fever  had 
occurred.  One  at  Regent's  Lane,  Belmont,  had  since 
been  discharged  from  the  colonial  hospital,  another  was 
still  under  treatment  at  that  institution,  while  the  third 
case,  from  No.  48  Charlotte  Street,  had  proved  fatal. 
In  each  case  the  premises  were  disinfected  and 
advice  given  as  to  the  storage  of  water,  etc.,  and  the 
necessity  of  keeping  water-closets  and  drains  in  a 
sanitary  condition.  The  following  premises  were 
disinfected  for  pulmonary  and  tuberculous  diseases : — 
No.  6  Regent  Street,  23  Belle  Eau  Road,  20  Frederick 
Street,  36  Piccadily  Street,  5  Baden  Powell  Street, 
2  Rosslyn  Lane,  46  Charlotte  Street,  2  Brunton  Lane, 
and  40  Marine  Square.  The  number  of  shops  inspected 
was  165.  Twenty-three  prosecutions  were  instituted, 
and  convictions  obtained  in  all  save  one,  where  the 
defendant  was  not  found.  Twenty-one  were  against 
occupiers  for  failing  to  keep  their  premises  free  from 
stagnant   water   liable  to  breed  mosquitos.     A  fine  of 


FIG.   28. — LAEGE   CONCEETE  DRAINS,  POET   OE   SPAIN,   TEmiDAD. 


[Face  page  204. 


STEGOMYIA  SURVEY  205 

2s.  6d.  or  7  days'  imprisonment  was  imposed  in  20  cases, 
whilst  one  defendant,who  was  fined  £3  or  14  days, 
elected  to  go  to  jail.  In  one  case  against  an  owner 
for  not  complying  with  an  order  served  for  the  emptying 
and  disinfecting  of  a  cesspit,  the  defendant  was  fined  £1 
or  14  days'  imprisonment.     The  fine  was  paid. 

Trinidad  is  an  example  of  what  can  be  done  by 
proper  medical  organisation  and  equipment.  Con- 
sidering that  the  total  population  of  the  island  is  over 
300,000,  and  that  of  Port  of  Spain  over  70,000,  the 
yellow  fever  outbreak  of  1907-1908  has  been  a  very 
small  one. 

The  success  of  the  present  prophylactic  measures 
should  stimulate  Trinidad  to  perfect  its  machinery  still 
more ;  more  especially  because  it  has  a  volcano  ever 
ready  at  hand  in  the  form  of  Venezuela.  The  success 
which  the  medical  authorities  have  had  should  also 
for  ever  banish  the  pessimistic  and  progress-destroying 
doctrine  of  miasm. 

Stegomyia  Survey. — If  the  enquirer  wishes  to  under- 
stand why  yellow  fever  and  plague  have  not  taken  root 
in  Port  of  Spain,  let  him  do  as  I  did,  and  make  a 
detailed  examination  of  the  yards  and  houses  in  the 
various  sections  of  the  town.  Altogether,  I  visited  211 
lots  in  the  poorest,  middle  -  class,  and  better  -  class 
quarters  in  the  town.  I  found  the  yards  on  the  whole 
clean  and  free  from  odds  and  ends,  and  in  many  cases 
concreted.  I  was  glad  to  note  a  great  absence  of  bush 
in  the  yards ;  there  was  nothing  to  impede  the  sun's 
rays  nor  the  fresh  air.  I  also  noticed  a  useful  innova- 
tion in  the  fact  that  the  down-spouts  of  many  of  the 


206  HEALTH  PROGRESS  IN  TRINIDAD 

roof-gutters  were  conducted  directly  over  the  yard 
drain,  thus  preventing  placing  a  barrel  under  it ;  in 
some  cases  indeed  there  were  no  roof-gutters  at  all,  in 
order  to  preclude  the  possibility  of  water  lodging  there, 
as  it  so  often  does.  In  the  211  lots  I  examined,  for 
larvse, — 


Barrels 

27 

Tubs 

221 

Buckets 

101 

Jars  . 

31 

Kerosene  tins 

22 

Total 

402  receptacles 

Larvae  were  found  in  24  out  of  the  211  lots. 

The  first  striking  fact  is  the  small  number  of  barrels. 
Of  all  the  towns  which  I  have  visited,  Port  of  Spain 
contains  the  smallest  number  relatively,  and  no  doubt 
this  is  the  reason  why  the  Stegomyia  larvae  were  also 
scarce.  It  will  be  noted  that  there  is  a  large  quantity 
of  tubs ;  these  I  found  usually  exceedingly  clean ;  they 
are  used  for  washing  only.  In  the  majority  of  yards 
there  were  water-taps,  and,  as  I  have  mentioned  above, 
the  down  rain-water  spouts  were  turned  directly  over 
the  drains  without  the  intervention  of  a  barrel.  On 
these  tours  of  inspection  I  was  accompanied  each  morn- 
ing by  Surgeon-General  Clare  and  Dr  C.  F.  Lassalle,  the 
chief  sanitary  inspector,  and,  later  on  in  the  month,  by 
Dr  J.  R.  Dickson,  who  had  returned  from  leave  of 
absence.  In  my  opinion,  they  all  deserve  unstinted  praise 
for  the  excellent  condition  of  the  yards.  The  sani- 
tary authority  is  indeed  fortunate  in  having  as  its  two 
chief  sanitary  inspectors  ^uch  highly  qualified  medical 


MALARIA  IN  TRINIDAD 


207 


men  as  Drs  Lassalle  and  Dickson.  Whilst  in  Port  of 
Spain  the  ordinary  receptacles  for  breeding  mosquito 
larvae  are  few,  it  is  worthy  of  note  that  the  taste  of  the 
inhabitants  for  flower  cultivation  has  introduced  a 
special  water-container  which  does  tend  to  encourage 
the  breeding  of  mosquito  larvse — these  are  known  as 
antiformicas. 

Antiformicas  are  various  forms  of  water  receptacles 
used  for  the  prevention  of  umbrella  ants  reaching 
flowers.  They  are  made  either  in  the  form  of  metal 
or  earthenware  rings  or  collars,  which  surround  each 
plant,  and  capable  of  holding  water,  or  as  a  cement 
drain  running  round  a  flower-bed.  They  are  all  liable 
to  breed  mosquitos,  because  the  water  may  be  left  too 
long  in  them. 

Malaria  in  Trinidad. 
General  Mortality  and  Malaria  Rates  in  Port  of  Spain. 


Year. 

Deaths. 

Death-rate. 

Deaths  from 
Malaria. 

Eate  per 
1000. 

1904-1905 
1905-1906 
1906-1907 
1907-1908 

1638 
1949 
1909 
1838 

27-76 
32-48 
31-81 
30-63 

32 

74 
78 
71 

0-54 
1-23 
1-03 
1-18 

Dr  E.  Prada,  secretary  of  the  medical  board, 
Trinidad,  informs  me  that  blackwater  fever  is  un- 
commonly prevalent  in  the  adjacent  island  of  Tobago  ; 
in  fact,  that  it  is  the  disease  of  Tobago,  and  attacks  all 
new  arrivals,  people  from  the  neighbouring  island  of 
Trinidad  being  liable  to  it ;  yet  in  Trinidad  itself 
blackwater  fever  is  rare.     Another  interesting  fact   is 


208  HEALTH  PROGRESS  IN  TRINIDAD 

that  in  Trinidad,  just  as  in  British  Guiana,  the  Bar- 
badian labourers  are  very  liable  to  malaria. 

Mosquito  Surrey  of  Trinidad  and  Entomological 
Researches. — Mr  F.  W.  Urich,  Government  entomolo- 
gist, is  doing  excellent  work  in  making  a  complete 
survey  of  the  mosquitos  of  the  island  of  Trinidad,  and 
co-operating  with  the  medical  authority  and  the 
educational  authority  in  pointing  out  the  breeding 
places  of  the  harmful  mosquitos.  He  has  prepared  a 
series  of  documents  and  photographs  showing  the 
dangerous  species  and  where  they  breed,  and  also  the 
simple  means  which  may  be  taken  to  prevent  their 
breeding.  He  has  also  prepared  a  card  pointing  out 
the  fish  which  eat  mosquito  larvse.  In  this  respect 
his  educational  work  is  more  up  to  date  than  anything 
I  have  seen  as  yet.  Mr  Urich  mentions  several  species 
of  predatory  larvae  which  attack  mosquito  larvae,  and 
has  furnished  me  with  specimens. 

I  visited,  on  10th  May,  some  special  breeding 
grounds  of  mosquitos  with  Dr  Clare  and  Mr  F.  W. 
Urich.  The  latter  demonstrated  the  work  he  was 
doing  upon  the  breeding  places  of  mosquitos.  He 
divides  the  tree  and  plant  breeding  places  into  three 
groups — namely,  the  "rot-hole,"  the  "bromelia,"  and 
the  "bamboo."  In  an  examination  of  five  trees,  we 
found  larvae  present  in  the  rot-holes  in  three  of  them. 
They  were  readily  syphoned  out  with  a  pipette.  A 
considerable  number  of  the  species  were  predatory. 
Mr  Urich  is  describing  a  bromelia  Anopheline,  which 
he  thinks  may  be  a  source  of  malaria  upon  the  cocoa 
and  other  plantations.     I  also  visited  the  Caroni  swamp 


FIG.   29.^ — A   CONCRETE   EOADSIDE   DEAIN,   POET   OF   SPAIN,   TEINIDAD. 


[Face  page  208, 


THE  ANOPHELINES  OF  TRINIDAD  209 

and  saw  breeding  places  o^  Anophelines.  This  district 
has  a  bad  reputation  for  malaria.  The  breeding 
places  are  the  small  pools,  as  the  larger  channels  are 
stocked  with  fish.  The  district  ought  to  be  well 
drained. 

List  of  Anophelines  in  Trinidad  (on  the  authority  of 
Mr  Urich)  :— 

1.  Anopheles  tarsimacula,  Goeldi    .         .       Grassy  pools. 

A.  argyrotarsis  and  A.  albivianus. 
2-  A.  mediopunctatus,  Theo    ...  „ 

Cycloleppteron  (m.). 

3.  A.  bellator,  D.  and  K,       .  .         .       Bromelia. 

A.  lutzii. 

4.  A.  maculipes,  Theo   ....       Grassy  pools. 

Arrihalzagia  maculipes. 

5.  A.  apimacula,  D.  and  K.  .  .  „ 

Proc.  Biological  Soc.  of  Washington,  vol.  xix.,  p.  136. 

"Generally  speaking,  Anopheles  tarsimacida,  Goeldi 
(Syn.  A.  argyrotarsis  or  albimanus),  is  the  common 
species  on  lowlands,  especially  in  badly-drained  districts 
near  swamps,  generally  occurring  on  the  coast.  Associ- 
ated with  it  are  to  be  found  A.  maculipes,  Theo,  and 
rarely  A.  mediopunctatus,  A.  bellator,  D.  and  K.  A 
species  closely  allied  to  A.  lutzii,  Theo,  is  a  forest- 
inhabiting  species  living  only  in  Bromelise.  It  is  found 
in  hills  where  there  is  no  water.  It  is  also  found  on 
cocoa  estates,  where  Bromelise  are  allowed  to  thrive  in 
abundance  on  the  shade  trees.  Common  in  forest  all  over 
the  island  and  on  many  cocoa  estates.  My  attention 
has  often  been  called  to  the  fact  by  country  people  that 
fever  is  prevalent  in  recently  felled  land  :  I  put  it  down 
to  this  species  and  not  to  A.  tarsimacula.     Dr  Dickson 


210  HEALTH  PROGRESS  IN  TRINIDAD 

has  promised  to  find  out  whether  it  is  a  malaria  carrier 
or  not."  Dr  Lassalle  also  in  1903  made  a  collection  of 
the  principal  mosquitos  of  Trinidad.  The  description 
of  these  is  published  in  the  1902-3  Annual  Report  of 
the  Surgeon-General. 

In  addition  to  Drs  Urich  and  Lassalle,  Trinidad  is 
also  fortunate  in  having  a  volunteer  in  Mr  Caracciolo. 
In  fact,  the  entomological  equipment  of  Trinidad  is 
exceedingly  good  and  is  bearing  excellent  fruit. 

There  has  been  a  co-operation  between  the 
agricultural  and  scientific  departments  under  the 
leadership  of  Lieutenant-Colonel  Collens,  Professor 
Carmody,  and  the  Acting  Superintendent  of  the  Botanic 
Gardens,  Mr  Evans,  the  practical  result  of  which  has 
been  that  since  1905,  systematic  instruction  has  been 
given  in  insect  pests  to  pupil  teachers  and  others,  and 
still  more  recently  the  system  has  been  further 
strengthened  by  co-operation  with  the  medical 
authority,  so  that  sanitary  inspectors  are  now  being 
trained  by  the  Surgeon-General's  ofiicers,  Doctors 
Dickson  and  Lassalle,  and  Mr  F.  W.  Urich.  In  my 
opinion,  this  colony  is  one  of  the  most  advanced  in  this 
respect,  and,  ha^ang  made  such  a  good  start,  I  now 
suggest  that  a  bacteriological  and  medical  entomological 
department  be  established  as  soon  as  possible,  so  as  to 
reap  at  once  the  advantages  which  must  accrue.  The 
usefulness  of  such  a  department  to  the  colony  cannot  be 
over-estimated:  it  would  assist  the  medical  profession 
and  agriculture.  It  is  a  most  happy  coincidence  that 
Trinidad  at  the  present  moment  possesses  a  group  of 
admittedly  keen  investigators  second  to  none.     If  this 


SANITARY  SCIENCE  TRAINING  211 

scientific  department  were  established  and  regular 
transactions  published,  the  gain  to  tropical  medicine, 
and  to  the  advancement  of  health  and  commerce  would 
be  very  great. 

Sanitary  Science  Training. — In  reply  to  a  communica- 
tion addressed  to  the  Government  of  Trinidad  by  the 
then  Secretary  of  State  for  the  Colonies  (Mr  Alfred 
Lyttleton),  dated  20th  May  1904,  both  the  Surgeon- 
General  and  the  Director  of  Education  described  the 
steps  which  were  being  taken  to  teach  elementary 
tropical  hygiene  in  the  schools.  They  both  sympa- 
thised with  the  necessity  for  this  teaching,  and  since 
that  date  much  has  been  done  by  the  Director  of 
Education,  Surgeon-General  Clare,  Dr  Dickson,  and 
Mr  F.  W.  Urich ;  indeed  their  work  in  this  respect 
is  admirable,  and  might  with  advantage  be  followed  in 
other  colonies. 

Annual  reports  are  published  by  the  Government 
analyst.  Professor  Carmody,  containing  much  useful 
information  upon  subjects  relating  to  public  health. 

On  the  training  given  to  sanitary  inspectors,  Surgeon- 
General  Clare  writes  me  as  follows  : — 

The  small  elementary  book  published  by  Dr 
Dickson  on  Hygiene,  forms  the  basis  of  the  instruc- 
tion given  in  a  course  of  lectures  extending  over 
three  months  to  candidates  training  to  become 
assistant  sanitary  inspectors  ;  the  third  course  is  now  in 
progress. 

Dr  Dickson's  notes  have  been  re-edited  and  further 
developed  and  extended,  and  a  second  edition  is  now  in 
the  printer's  hands,  and  will  shortly  be  published.  Dr 
Dickson's   work    is    one   of   the  text-books   which    I 


212  HEALTH  PROGRESS  IN  TRINIDAD 

recommended  for  the  use  of  elementary  school  teachers, 
for  whom  I  suggested  that  courses  of  lectures  on 
hygiene  should  be  arranged  and  that  hygiene  should 
be  made  a  subject  for  teachers'  certificate  examina- 
tions. 

Elementary  Instruction  in  Hygiene. — The  Director  of 
Education,  Lieutenant-Colonel  Collens,  has  inaugurated 
a  very  admirable  system  of  elementary  instruction  in 
hygiene,  especially  in  relationship  to  mosquito-borne 
diseases,  and  for  this  purpose  various  pamphlets  have 
been  drawn  up,  two  by  Dr  Dickson,  one  of  an  elementary 
but  very  practical  kind,  and  the  other  of  a  more  detailed 
description.  These  two  pamphlets,  together  with 
Front's  pamphlet  on  Hygiene,  are  extensively  used 
throughout  the  colony  in  the  schools,  and  there  is  no 
doubt  that  this  educational  hygienic  campaign  is  bearing 
fruit,  and  that  it  should  be  copied  in  all  other  colonies. 
It  appears  to  me  to  be  the  first  serious  attempt  at 
teaching  tropical  hygiene  in  schools.  In  addition,  a 
systematic  series  of  lectures  in  hygiene  and  hygienic 
instruction  generally  is  given  to  candidates  wishing  to 
become  sanitary  inspectors  in  the  town  or  Port  of 
Spain.  These  demonstrations  are  given  by  Drs  Dickson 
and  Lassalle.  In  this  way  it  is  hoped  to  procure 
for  the  town  of  Port  of  Spain  a  corps  of  well-trained 
sanitary  inspectors. 

To  show  that  this  system  is  put  into  practice,  I  insert 
the  following  notice  from  the  Port  of  Spain  Gazette  of 
9th  May  1909  :— 

At    8.55    o'clock    yesterday    morning,    Dr    C.    F. 


TEACHING  OF  HYGIENE  213 

Lassalle,  D.P.H.,  continued  his  lecture  on  hygiene  at 
the  Victoria  Institute,  before  a  number  of  the  con- 
stabulary and  elementary  teachers.  The  number  of  the 
latter  has  increased  by  five.  The  lectm-er  reviewed  the 
nervous,  the  circulatory,  and  the  alimentary  systems  of 
the  human  body. 

To  illustrate  the  earnestness  of  the  educational 
movement  in  Trinidad,  I  insert  here  for  the  guidance  of 
other  colonies  the  following  report  upon  education 
which  has  been  furnished  me  by  Colonel  Collens,  the 
inspector  of  schools. 

Report  on  the  Teaching  of  Hygiene  in  Trinidad 
AND  Tobago. 

A  course  of  weekly  lectures  on  hygiene  and  sanita- 
tion, lasting  for  a  term  and  ending  with  a  test 
examination,  has  been  given  this  year  at  the  Victoria 
Institute  by  Dr  Dickson,  Assistant  Medical  Officer  of 
Health.  Though  intended  mainly  for  assistant  sanitary 
inspectors  and  candidates  for  similar  posts,  it  was  also 
open  to  primary  school  teachers,  and,  as  the  lectures 
were  given  at  a  convenient  hour  on  Saturdays,  several 
schoolmasters  took  advantage  of  the  opportunity  thus 
afforded  them. 

As  a  further  step  towards  the  teaching  of  hygiene  in 
our  schools,  it  has  been  placed  by  the  Board  of  Educa- 
tion upon  the  syllabus  of  the  Teachers'  Certificate 
Examination,  and  will  consequently  form  one  of  the 
optional  subjects  in  the  next  annual  examination,  to 
be  held  in  April  1909.  The  text -books  specially 
recommended  for  study  are  Dr  Front's  Elementary 
Hygiene  and  Sanitation,  and  Dr  Dickson's  Lecture  Notes 
on  Elementary  Hygiene.  There  has  been  such  a  demand 
for  the  latter,  that  the  first  impression  is  exhausted  ;  but 
a  new  and  revised  edition  is  in  the  hands  of  the  printer, 
and  will  shortly  be  ready  for  issue. 


214  HEALTH  PROGRESS  IN  TRINIDAD 

Mr  F.  W.  Urich,  F.E.S.,  of  the  Education  Depart- 
ment, has  prepared  one  or  two  lantern  sHdes,  illustrating 
the  life  history  of  the  mosquito,  and  has  been  successful 
in  obtaining  some  good  negatives,  from  which  he  can 
add  to  the  number. 

In  many  schools  hygiene  is  often  taken  at  the 
annual  examination  as  the  subject  for  object-lessons, 
particular  stress  being  laid  upon  the  part  insects  play  in 
the  spread  of  malaria  and  other  diseases. 

I  have  now  brought  forward  sufficient  proof  to  show 
the  earnest  nature  of  the  educational  movement  in 
Trinidad,  and  it  is  with  still  greater  pleasure  that  I  can 
myself  testify  to  the  support  which  both  the  Roman 
Catholic  and  the  Protestant  clergy  give  to  this  bene- 
ficent and  humanitarian  movement. 

Sanitary  Administration. — The  ordinances  187  and 
188  form  the  two  Health  Acts,  and  in  addition  to  these 
there  are  several  special  ordinances  relating  to  food  and 
drugs,  to  lepers  and  yaws,  to  the  registration  of  births 
and  deaths,  to  vaccination,  to  bakehouses,  to  water, 
sewers,  the  medical  board,  etc.  A  new  ordinance  has 
been  drafted  in  1909,  relating  to  public  health,  and  in  it 
the  sanitary  authority  has  inserted  clauses  which  relate 
to  larval  and  mosquito  destruction,  in  connection  with 
yellow  fever  and  other  insect-borne  diseases.  It  is  in 
these  respects,  therefore,  fully  up  to  date. 

The  General  Board  of  Health. — The  constitution  of 
the  General  Board  of  Health  is  regulated  by  section  3 
of  Ordinance  187 — its  powers  are  purely  advisory,  and 
it  is  not  entrusted  with  any  funds ;  the  members  at 
present  are : — 


-  6x-officio. 


HEALTH  ADMINISTRATION  215 

The  Governor,  President. 

Hon.  Surgeon-General,  Ckamnan 

in  Governor's  absence. 
The  Mayor  of  San  Fernando. 
Chief  Commissioner,  Port  of  Spain. 

_     _  V  [Nominated  by  Medical  Board. 

Dr  S.  Lawrence.   J 

Hon.  Protector  of  Immigrants, 

„      Attorney- General. 

„      Director  of  Public  Works. 

„      Inspector- General  of  Constabulary. 
The  Director  of  Agriculture. 
The  Crown  Solicitor. 
Dr  R.  H.  E.  Knaggs. 
Dr  J.  W.  Eakin. 
Dr  E.  I.  Read. 
Dr  E.  Prada. 
Mr  A.  D.  Owen. 

The  Sui'geon-General  is  also  Chief  Medical  Officer 
of  Health  for  the  Colony;  and  there  is  an  Assistant 
Medical  Officer  of  Health,  who  is  also  sanitary  inspector 
for  Port  of  Spain  under  the  Surgeon- General's  direction. 

Port  of  Spain  has  also  a  Town  Board  of  its  own, 
which  consists  of  eleven  householders  nominated  by  the 
Governor,  who  also  appoints  one  of  them  to  be  Chief 
Commissioner  with  salary  fixed  by  Legislative  Council. 
This  board  discharges  all  the  functions  of  the  late  Town 
Commissioners,  the  Water  Authority,  and  the  Sewerage 
Board,  and  exercises  control  over  water-supply,  sewer- 
age, drainage,  etc.,  of  the  town :  the  Surgeon-General 
and  Chief  Medical  Officer  of  Health  for  the  colony  has 
no  jurisdiction  in  these  matters  in  Port  of  Spain. 

In  the  country  districts  the  Warden  is  the  sanitary 
inspector  and  the  executive  officer  in  charge  of  the 
general  sanitation  of  his  ward — in  some  wards  he  has 


216  HEALTH  PROGRESS  IN  TRINIDAD 

assistant  sanitary  inspectors,  who  are  also  his  ward 
ofiBcers — many  of  these  officers  are  devoid  of  any  training 
in  sanitary  matters. 

The  Port  of  Spain  Town  Board  has  no  medical 
officer  of  its  own,  as  in  the  case  of  Georgetown, 
Demerara,  nor  has  it  a  Town  Supervisor.  It  employs, 
however,  a  Chief  Engineer  (Mr  E.  V.  Acton).  There- 
fore the  Sm-geon- General  is  the  official  medical  head, 
not  only  of  the  colony,  but  also  of  the  town  of  Port  of 
Spain,  and  he  has  under  him  an  assistant  medical  officer 
of  health,  who  is  called  Sanitary  Inspector  of  Port  of 
Spain.  This  is  Dr  Dickson,  and  the  arrangement  seems 
to  work  admirably.  Thus  Dr  Clare  has  power  to  see 
that  the  sanitary  arrangements  of  the  houses  in  Port  of 
Spain  are  kept  up  to  the  proper  standard,  and  it  is  he 
who  initiates  antilarval  or  other  special  measures.  He 
has,  however,  no  jurisdiction  over  drainage,  sewerage,  or 
water-supply.  These  are  functions  that  are  taken  over 
by  the  Port  of  Spain  Town  Board. 

In  other  colonies  in  the  West  Indies  the  medical 
officer  for  the  town  may  not  be  under  the  direct  control 
of  the  Surgeon- General.  On  the  other  hand,  in  Port  of 
Spain  the  chief  sanitary  officer  is  practically  the  medical 
officer  of  health  of  the  town,  and  is  the  assistant  of  Dr 
Clare. 

Sanitary  Staff  of  the  Port  of  Spain. 

Surg  eon- General   and  Chief  Medical  Officer   of  Health    of  the 

Colony. 
Assistant    Medical    Officer    of    Health,    who    is    also    the    Chief 

Sanitary  Inspector  of  Port  of  Spain. 
Five  Assistant  Sanitary  Inspectors. 


SANITARY  STAFF  217 

Eight  extra  Assistant  Sanitary  Inspectors. 

Eight  cleansing  gangs  of  three  men,  each  under  a  headman. 

One  headman  at  Belmont. 

Two  boys  for  handling  rats. 

One  clerk  for  recording  rats,  paying  for  rats,  etc. 

One    man    for    disinfecting    and     spraying     premises,    railway 

carriages,  etc. 
Note.  —  Eight    extra    Assistant    Sanitary    Inspectors    and    eight 

cleansing  gangs  employed  since  outbreak  of  plague. 
One   headman  at  Belmont  specially   employed  in  Antimosquito 

work. 

Assistant  Sanitary  Inspectors: — 

One  is  engaged  in  clerical  work,  keeping  of  books  and  records, 
preparing  of  returns,  and  assisting  the  Sanitary  Inspector  generally 
in  office  work. 

The  town  is  divided  into  twelve  districts,  one  of  which  is  allotted 
to  each  of  the  other  twelve  Assistant  Sanitary  Inspectors. 

Districts  of  Assistant  Sanitary  Inspectors : — 

Mr    Thorne. — Duncan    Street,*   Nelson    Street,     George    Street, 

Charlotte  Street,  and  all  cross  streets  from  the  river  to  Henry 

Street,  from  Park  Street  to  the  sea. 
Mr  Mark. — Henry  Street,  Pembroke  Street,  Chacon  Street,  and  all 

cross    streets   from    Henry  to    Abercromby    Street   (south    of 

Park  Street). 
Mr    Huggins. — Abercromby  Street,  St    Vincent    Street,  Edward 

Street,    part    of    Sackville    Street,    and    cross    streets    from 

Abercromby  to  Richmond  (south  of  Park  Street). 
Mr  Rawlins. — Richmond  Street,  Sackville  Street  (from  Richmond 

Street    to   the   sea),  Francis    Street,  Charles  Street,   London 

Street,    Kew    Place,    Fraser    Street,    Philip    Street,   Victoria 

Square,  Scott  Bushe  Street. 
Mr  C.  Herbert. — From  Abercromby  Street  (north  of  Park  Street) 

to  Charlotte  Street  up  to  Queen's  Park  East. 
Mr   Sylvester. — From   Abercromby    Street  to    Victoria    Avenue 

(north  of  Park  Street), 
Mr  Parkinson. — Victoria  Avenue  to  St  Clair  Avenue. 
Mr  Henly. — Woodbrook  District. 
Mr  Henry. — Rose  Hill  District. 


218  HEALTH  PROGRESS  IN  TRINIDAD 

Mr  Roach. — From  Clifton  Hill  to  South  Quay,  including  Plaisance 

Road  and  Picton  Road  (east  of  Dry  Rivei"). 
Mr  R.  Herbert. — Belmont  District  up  to  Belle  Eau  Road. 
Mr  Smith. — From  Belle  Eau  Road  to  Park  Street  East. 


Cost. — Month  of  April. 

Five  Assistant  Sanitary  Inspectors  (£75  to  £100  per  annum 
each)  .....      £38  15     0 

Eight  extra  Assistant  Sanitary  Inspectors 
(4s.  2d.  per  working  day),  and  Rat  Record- 
ing Clerk  (2s.  lid.  per  day)  .  .  49   17     6 

Eight  gangs  of  three  men  each,  and  two  boys 

for  rat  handling       .  .  .  .  60     9     9i 

One  man  for  disinfecting  and  spraying 
premises,  railway  carriages,  etc.  (2s.  per 
day)  .  .  .  .  .249 

£151     7     Q^ 

From  the  preceding  account,  it  will  be  seen  that 
Trinidad  is  fortunate  in  possessing  an  excellent  sanitary 
organisation,  and  it  is  therefore  not  surprising  to  find 
how  excellent  have  been  the  public  works  carried  out 
under  the  various  departments,  including  drainage  and 
road-construction.  The  accompanying  illustrations  are 
proof  of  the  excellence  of  the  roads  and  the  side  drains, 
as  well  as  of  the  large  storm- water  drains  which  have 
been  made  to  take  the  bed  of  former  small  gullies  and 
so  avoiding  thereby  the  formation  of  pools.  These 
drains  are  splendid  examples  of  their  kind,  and  can  well 
serve  for  models  for  tropical  towns ;  they  are  a  potent 
factor  in  preventing  malaria.  In  Port  of  Spain  there  is 
everywhere  evidence  of  concrete.  The  surfaces  of  very 
many  of  the  yards  are  concreted,  and  as  this  has  been 
done  in  the  crowded  quarters  of  the  town,  it  has  in  a 


HEALTH  CONDITIONS  ON  ESTATES  219 

great  measui-e  contributed  to  dimmish   both   rats  and 
fleas,  and  therefore  to  lessen  the  dangers  from  plague. 

The  yards  are  kept  clean  and  the  roadways  are  as 
free  from  puddles  as  in  any  well-administered  town  in 
England. 

Health  Conditions  upon  Estates  —  Malaria  and 
Ankylostomiasis. — I  visited  three  of  the  sugar  estates  of 
Trinidad  —  namely,  Orange  Grove,  that  of  the  Usine 
St  Madeleine,  and  Caroni.  The  impression  which  I 
obtained  was  that  ranges  or  barracks  were  clean  and 
well- ventilated,  and  that  the  labourers  and  their  families 
appeared  contented  and  happy.  They  have  schools  and 
hospitals  of  their  own  upon  the  estates.  Eain  or  river- 
water  is  used  for  drinking  purposes.  I  did  not  see  any 
screened  water -barrels,  but  on  the  other  hand,  on  one 
estate  no  larvse  were  to  be  found  in  the  barrels,  as  they 
each  one  of  them  contained  a  fish.  The  latrine  accom- 
modation was  indifferent.  Both  water-supply  and 
sewage  disposal  leave  plenty  of  room  for  improvement, 
and  obviously  the  expenditure  is  well  worth  the 
consideration  of  the  estate  managers  and  the  Govern- 
ment. In  his  Annual  Report  to  the  Protector  of 
Emigrants,  the  Surgeon- General  states  : — 

I  forward  herewith  the  usual  statistical  returns  for 
the  financial  year  ended  31st  March  1908,  as  required 
from  me  by  section  233  of  the  Immigration  Ordinance. 

The  total  indentm^ed  immigration  population  dealt 
with  by  the  medical  visitors  in  the  year  under  review 
was  10,929,  of  whom  9266  were  distributed  on  sugar 
estates  and  1663  on  cocoa  estates. 

The  total  number  of  cases  treated  within  the  year 
was  28,572;  of  these  26,039  occurred  on  sugar  estates 


220  HEALTH  PROGRESS  IN  TRINIDAD 

and  2533  on  cocoa  estates.  262  deaths  are  recorded 
on  sugar  estates  and  19  deaths  on  cocoa  estates 
yielding  for  their  total  populations  respectively,  per- 
centage rates  of  2*8  and  1*14,  and  a  gross  mortality 
rate  of  2*56  on  the  total  population. 

"  The  incidence  of  sickness  amongst  indentured 
immigrants  on  sugar  estates  as  compared  with  cocoa 
estates  appears  to  be  nearly  twice  as  great,  the  records 
yielding  281  and  152-3  respectively,  with  a  correspond- 
ing variation  of  the  mortality  rates :  this  very  marked 
contrast  may  be  due  to  the  more  arduous  and 
exhausting  labour  conditions  on  sugar  estates,  but  I 
think  it  is  also  referable  in  no  small  degree  to  the  much 
greater  prevalence  of  malarial  diseases  on  sugar  estates ; 
indeed,  the  '  Principal  Diseases  Treated '  nearly  all 
present  themselves  relatively  in  much  larger  numbers 
on  sugar  estates  than  on  cocoa  plantations." 

''Malarial  fevers  are  responsible  for  more  than  a 
third  (35*8  per  cent.)  of  the  gross  tale  of  sickness  amongst 
indentured  immigrants,  and  the  groups  of  estates  in  the 
two  Naparima  districts  contribute  nearly  one-half  of 
the  total  number  of  these  cases ;  on  these  estates  also, 
nearly  half  of  the  total  cases  of  sickness  of  immigrants 
is  attributed  to  affections  of  malarial  origin,  and  in 
other  districts  perseverance  in  Chaguanas,  Sevilla, 
Exchange,  and  Waterloo  in  Couva,  and  Esperanza  in 
Pointe-S-Pitre,  exhibit  in  their  case-books  a  large 
incidence  of  this  fertile  and  preventable  source  of 
illness  and  diminished  labour  supply." 

It  is  worthy  of  note  that  whilst  Uackwater  is  not 
recorded  in  Trinidad,  yet  it  is  often  met  with  in  the 
adjacent  island  of  Tobago ;  thus  four  cases  were 
reported  in  the  year  1902-3. 

Ankylostomiasis. — With  regard  to  this  disease,  the 
Surgeon- General  states  :  "  Until  greater  precision  in 
diagnosis  and    accuracy   of   record  are   obtained,   the 


ANKYLOSTOMIASIS 


221 


statistical  returns  under  this  as  well  as  other  headings 
must  be  unreliable,  and  the  difficulty  of  devising  and 
introducing  measures  for  the  control  of  disease  must  be 
correspondingly  increased,  as  accurate  information 
about  the  prevalence  and  distribution  of  any  particular 
disease  forms  one  of  the  essential  factors  on  which  to 
base  operations  for  its  prevention." 

Return  of  Cases  of  Ankylostomiasis  treated  at  medical 
Institutions  and  Estates  during  the  years  1904-5, 
1905-6,  1906-7,  and  1907-8. 


Period. 

Medical 
Institutions. 

Estate  Hospitals. 
Sugar.                     Cocoa. 

Total. 

1904-1905 
1905-1906 
1906-1907 
1907-1908 

Total  .     . 

216 
356 
427 
430 

158 
711 
107 
114 

17 

24 

5 

7 

391 

1091 
539 
551 

1429 

1090 

53 

2572 

In  the  Surgeon-General's  annual  returns,  ankylosto- 
miasis receives  a  full  measure  of  attention,  as  the 
following  extracts  show  : — 

Ankylostomiasis,  1905-6. 

"This  disease  has  continued  to  be  very  prevalent, 
more  especially  among  the  immigrant  labourers  on  the 
estates,  and  is,  I  fear,  on  the  increase.  There  is  no 
doubt  that  the  extensive  prevalence  of  the  disease 
among  the  labouring  class  is  a  matter  of  very  serious 
importance,  as  it  is  probably  directly  or  indirectly  the 
most  potent  cause  of  inefficiency,  and  it  is  of  the 
highest  importance  that  such  measures  as  may  be 
possible  for  the  prevention  and  cure  of  the  disease 
should  be  generally  adopted. 


222  HEALTH  PROGRESS  IN  TRINIDAD 

"With  regard   to   the  indentured   immigrants,  the 
following  measures  should  be  carried  out : — 

1.  Periodical    individual    inspection    and    ex- 

amination. 

2.  Prompt  treatment  of  those  affected. 

3.  The  compulsory  use  of  latrines. 

4.  The  proper  disposal  of  the  excreta. 

5.  The  smearinsj  of  the  feet  and  ankles  of  the 

labourers   with    coal-tar    before   going    to 
work  in  the  fields. 

6.  The  pro\asion  of  a  supply  of  pure  drinking- 

water. 

"  With  regard  to  the  general  population,  the  want  of 
control,  and  the  fact  that  many  people  in  apparent 
health  act  as  hosts  of  the  parasite  and  are  sources  of 
contagion,  make  it  difficult  to  recommend  practical 
measures  for  dealing  efficiently  with  the  disease." 

Ankylostomiasis,  1906-7. 

"Ankylostomiasis  continues  to  prevail  extensively, 
chiefly  among  the  Indian  population,  and  is  a  serious 
cause  of  disability  amongst  the  labourers  on  the  estates." 

"  I  have  taken  steps  to  carry  out  as  far  as  practicable 
the  measures  specified  in  my  last  annual  report  for 
controlling,  and  if  possible  stamping  out,  this  disease." 

"  Circulars  were  issued  to  all  district  medical  ofl&cers, 
directing : 

1.  The  systematic  examination  of  all  indentured 

immigrants,  and  the  treating  of  all  found 
infected ; 

2.  The  forwarding  of  a  monthly  return  of  cases  ; 

and    the   protector   of    immigrants   was  requested    to 
impress  upon  the  managers  of  estates  the  importance 


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ANKYLOSTOMIASIS  223 

of  giving  every  assistance  in  the  carrying  out  of  these 
measures,  including  the  providing  of  the  necessary 
appliances  for  the  examination  of  faeces.  I  regret  to 
say  that  the  estate  authorities  generally  have  not 
responded  cordially  to  this  appeal,  and  consequently 
little  has  yet  been  done  to  carry  out  the  scheme 
indicated." 


Labour  and  Ankylostomiasis. 

As  far  back  as  November  1901,  the  Hon.  G.  T.  Fen- 
vrick  and  Mr  Meaden  recommended  attention  being  given 
to  the  prevention  and  modification  of  ground-  or  water- 
itch,  and  for  this  purpose  a  committee  was  formed  and 
a  circular  drawn  up,  based  on  recommendations  by  Dr 
Bennett.     The  report  and  circular  are  as  follows  : — 

The  committee  having  carefully  considered  the 
letter  of  Mr  T.  H.  P.  Heriot  and  the  papers  by  Drs 
A.  B.  Dalghalty  and  R.  C.  Bennett  on  this  scourge 
of  the  field-labourers  of  the  colony,  beg  to  report : — 

That  in  their  opinion  the  disease  is  so  prevalent  and 
incapacitates  from  time  to  time  such  large  numbers  of 
our  labouring  population,  as  to  render  imperative  the 
adoption  of  such  measures  as  will  best  tend  to  its 
prevention  or  the  mitigation  of  its  severity. 

To  enable  the  society  to  recommend  to  employers 
of  field  labom'  the  best  measm-es  to  be  adopted,  the 
committee  think  the  employers  should  be  invited  by  the 
society  to  make  a  careful  trial,  extending  over  a  period 
of  twelve  months,  of  one  or  other  of  the  several  treat- 
ments for  prevention  and  cure  recommended  by  Dr 
Bennett,  and  to  keep  a  correct  record  on  certain  well- 
defined  lines  of  their  observations  and  the  results  of  the 
trial,  such  record  to  be  forwarded  to  the  secretary  of 
the  society  at  the  end  of  twelve  months. 


224  HEALTH  PROGRESS  IN  TRINIDAD 

A  form  of  circular  letter  to  be  addressed  to  the 
employers  is  herewith  submitted. 

The  report  of  a  commission  on  the  labour  question 
(agricultural)  in  the  colony,  presented  on  the  5th 
February  1906,  stated  :  "  The  Surgeon- General  attached 
the  greatest  importance  to  ankylostomiasis,  or  ground- 
itch,  attributing  to  it  the  prevalence  among  field- 
labourers  of  anaemia,  which,  in  its  turn,  produces 
liability  to  other  diseases  and  permanently  impaired 
energy.  .  .  .  We  have  already  touched  on  the  far- 
reaching  effects  of  ankylostomiasis,  and  we  need  now 
only  point  out  to  Your  Excellency  the  desirability  of 
adopting  here  the  preventive  measures  adopted  in 
British  Guiana  with  gratifying  results,  and  advocated 
for  Trinidad  by  the  Medical  Inspector  of  the  Indian 
Government  some  thirteen  years  ago." 

Eecommendations  were  made,  at  the  instance  of  the 
Secretary  of  State,  by  the  Surgeon-General,  for  the 
control  of  ankylostomiasis.  In  the  first  place,  a  return 
of  all  cases  in  estate  hospitals  and  on  plantations,  as 
well  as  a  report  for  the  last  four  years,  was  drawn  up 
by  the  Surgeon-General.  An  ordinance  was  then 
drafted,  and  this  ordinance  has  been  criticised  and 
reported  upon,  and  modifications  and  strengthening 
suggestions  made  by  the  Surgeon-General. 

I  am  of  opinion  that  the  measures  proposed  by  the 
Surgeon-General  should  be  put  into  practice  in  order 
to  stamp  out  ankylostomiasis. 

Proposed  Ankylostomiasis  Ordinance. 

Employers  of  agricultural  labour  to  provide  proper 
latrines,  under  penalty,  and  any  person  defecating 
except  in  a  latrine  to  be  liable  to  a  penalty. 

Object :  To  prevent  pollution  of  surface  soil. 

Note. — This  draft  ordinance  stands  referred  for  a 
report  from  a  committee,  and  is  now  receiving  attention. 


OTHER  DISEASES  225 

Plague.  —  As  has  already  been  seen  in  a  previous 
chapter,  plague  occupies  a  large  and  anxious  share  of 
the  attention  of  the  Government ;  regulations  have  been 
drafted  in  respect  to  it,  and  a  vigorous  sanitary  inspec- 
tion of  all  the  poorer  quarters  of  the  town  maintained, 
as  well  as  precautions  taken  against  rats  (see 
Appendix).  I  have  already  fully  commented  upon  the 
necessity  of  strict  supervision  of  arrivals  from  Venezuela. 

Smallpox  has  also  received  a  considerable  share  of 
attention,  and  an  interesting  report  has  been  drawn  up 
and  published  by  Dr  E.  Seheult.  The  subject  of  small- 
pox in  its  various  modifications  is  one  well  worthy  of 
scientific  study  in  the  West  Indies  (see  Appendix). 

Tuberculosis. — A  society  has  been  formed  in  Trinidad 
for  the  prevention  and  treatment  of  tuberculosis.  The 
society  is  doing  good  work  by  means  of  a  dispensary, 
and  by  publishing  leaflets  containing  instructions  for  the 
prevention  of  the  disease. 

Leprosy.  —  An  interesting  report  upon  this  disease 
for  the  year  1890  has  been  drawn  up  by  the  Acting 
Superintendent  of  the  Leper  Asylum ;  he  states  that : — 

Tuberculosis  occmTed  in  seven  cases  of  tubercu- 
lated  leprosy,  in  two  cases  of  mixed  leprosy,  and  in 
none  of  the  ansesthetic  variety.  These  give  as 
percentages : — 

In  tubercalated  leprosy      .  .         63  per  cent. 

„  mixed  leprosy    .  .  about  66         „ 

Dealing  in  a  similar  manner  with  diseases  of  the 
kidney,  he  found  that  it  occurred  as  follows  : — 

In  tuberculated  leprosy     .  about  36  per  cent. 

„  anaesthetic  leprosy         .  «      11  >, 

The  figures  are  too  small  to  enable  any  inferences  to 

p 


226  HEALTH  PROGRESS  IN  TRINIDAD 

be  drawn,  but  are  perhaps  worth  preserving  as  showing 
the  frequency  of  occurrence  of  these  diseases  in  the 
different  varieties  of  leprosy.  The  absence  of  any  form 
of  tuberculosis  in  the  anaesthetic  variety  of  the  disease 
is  to  be  noted. 

I  visited  the  leper  asylum  and  was  much  impressed 
with  the  care  and  attention  bestowed  upon  the  patients 
by  the  devoted  Roman  Catholic  Sisterhood  in  charge ; 
in  my  opinion,  the  colony  is  fortunate  in  being  able  to 
secure  the  services  of  this  earnest  and  humane  body 
of  women.  What  is  lacking  is  the  spirit  of  research  in 
the  medical  profession.  Would  that  this  could  be 
re^dved,  and  more  encouragement  given  it,  not  only  in 
the  West  Indies,  but  here  at  home. 

Ordinance  No.  190. — The  lepers'  ordinance  deals 
fully  with  the  regulation,  isolation,  and  care  of 
lepers. 

San  Fernando  General  Hospital. — On  16th  May  I 
visited  San  Fernando,  and  inspected  the  hospital,  which 
is  very  well  arranged  and  equipped.  The  institution 
has  a  pathological  department  under  Dr  Seheult,  and  it 
contains  many  interesting  specimens.  Dr  Seheult  is 
busily  engaged  making  investigations.  There  is  an 
excellent  mosquito-proof  room  in  the  hospital  for  the 
reception  of  suspects.  I  saw  Dr  Fabien,  who  is  town 
Medical  Officer  of  Health.  The  sanitation  of  San 
Fernando  is  not  as  advanced  as  that  of  Port  of  Spain, 
and  much  yet  is  to  be  done  in  the  form  of  water- 
supply  and  drainage.  More  sanitaiy  inspectors  are 
required  in  all  the  smaller  towns. 

Yaws. — I  visited  the  Yaws  Hospital,  Tacarigua,  with 


YAWS  227 

Dr  Clare  and  the  doctor  in  charge  (Dr  Alston).  Total 
number  of  cases,  184.  A  very  large  proportion  of  the 
cases  were  in  young  subjects  from  one  to  fifteen  years. 
No  evidence  that  there  were  any  congenital  cases. 
Indians  formed  about  50  per  cent,  of  the  cases.  The 
arrangements  in  the  hospital  were  excellent,  and  from 
an  examination  of  the  earlier  records  there  is  no  doubt 
that  since  the  institution  of  the  hospital  there  has  been 
a  marked  decrease  in  the  total  number  of  cases,  so  that 
bringing  in  the  patients  under  control  and  supervision 
has  had  a  very  beneficial  effect.  There  is  a  special 
Yaws  Ordinance,  No  191,  which  deals  with  the  notifica- 
tion, segregation,  and  care  of  cases  of  yaws. 


CHAPTER  XV 

HEALTH   PROGRESS  AND  ADMINISTRATION   IN    BRITISH 

GUIANA 

I  ARRIVED  in  this  colony  on  19th  April  1909.  British 
Guiana  has  been  described  as  the  "Tropical  Holland," 
and,  by  the  less  ambitious,  as  an  alluvial  "mud-flat," 
stretching  towards  the  sea-line,  on  which  Georgetown 
and  New  Amsterdam  are  built.  Numerous  large  rivers 
run  through  it  to  the  sea,  and  it  is  cut  up  into  lots 
and  plantations  by  innumerable  canals  and  trenches. 
Every  roadway  has  a  trench  on  either  side  of  it ;  for  it  is 
only  by  excavating  upon  each  side  that  a  dry  solid  road 
can  be  constructed.  The  appearance  of  this  flat,  low- 
lying,  alluvial  plain,  cut  up  into  rectangular  strips  by 
middle  and  side  dams,  middle  and  side  trenches,  is  very 
striking  to  the  newcomer ;  and  the  longer  one  studies  the 
country  and  its  treatment,  the  more  one  marvels  at  the 
ingenuity  and  the  pluck  of  those  pioneers  who  showed 
how,  in  spite  of  all  obstacles,  a  low-lying  swamp  can  be 
made  into  a  beautiful  and  productive  comitry,  with  good 
soHd  roads  and  avenues,  along  which  it  is  now  a  delight 
to  motor. 

"  As  the  level  of  the  land,"  wrote  Blair,  "  is  below 


O     c 


d    c 


THE  RESULT  OF  DRAINAGE  229 

that  of  the  sea,  the  cultivated  lands  require  embank- 
ments on  every  side.  Sluices  in  the  embankments 
when  the  tides  are  suitable  give  vent  to  the  surface 
drainage  of  the  land.  Numerous  drainage  and  navigable 
canals  intersect  the  country.  Within  Georgetown,  in 
1837,  besides  a  few  private  drains,  there  belonged  to 
the  public  31  miles  of  open  trenches,  varying  in  width 
from  2  to  10  feet,  communicating  by  62  tunnels,  and  these 
required  to  discharge  the  surface-water  of  the  city 
alone ! " 

The  great  obstacle  to  our  forefathers  in  British 
Guiana  was  the  intolerable  mosquito — not  that  they  then 
thought  so,  for  then  they  considered  that  the  marsh 
miasm,  which  we  have  already  in  the  opening  chapter 
discussed,  was  the  cause  of  all  fevers.  They  considered 
their  adopted  country  the  veritable  factory  of  miasms, 
with  mudbanks  and  swamps  everywhere,  and  the  odours 
arising  therefrom,  so  bad  in  Georgetown  down  by  the 
stelhngs,  that  the  freshly  painted  white  houses  were 
soon  covered  by  a  thin  deposit  of  black  metallic  lead, 
caused,  as  we  know,  by  the  conversion  of  the  white 
oxide  of  lead  in  the  paint  into  the  black  sulphide  by  the 
sulphuretted  hydrogen  emitted  from  the  marshes.  In 
those  days,  when  white  houses  were  being  turned  black 
in  Georgetown,  the  city  was  one  of  the  notorious 
"abodes  of  death,"  to  the  port  of  which  sailors  were 
only  induced  to  go  under  false  pretences,  believing  when 
they  joined  their  ship  that  they  were  going  to  some  other 
place  with  a  more  savoury  reputation. 

Those  were  the  days,  as  we  have  seen,  when  the 
Secretary  of  State  ventured  an  enquiry  why  69  per  cent. 


230       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

of  the  garrison  perished  from  yellow  fever  !  They  were 
the  times  when  every  new  arrival  as  a  matter  of  com'se 
got  yellow  fever  within  a  few  weeks  of  arrival.  We 
have  records  of  fever  in  1819,  1820,  1821,  1824,  1825, 
1826,  1828,  1830,  and  1831,  and  in  the  years  1820,  1821, 
and  1825,  yellow  fever  is  specially  mentioned.  In  1820 
the  mortality  from  that  disease  is  given  as  16  per  cent.  ; 
in  1821,  as  14  per  cent.  ;  and  in  1840  it  was  as  high  as 
69  per  cent.  Far  from  this  scom-ge  disheartening  the 
inhabitants,  it,  on  the  contrary,  set  men's  minds  thinking, 
and  British  Guiana  will  always  stand  out  as  a  colony 
in  which  great  medical  knowledge  has  been  a  striking 
feature.  The  distinguished  but  forgotten  Beauperthuy, 
as  we  have  seen,  finally  settled  in  the  colony ;  then 
later  Daniel  Blair  became  Surgeon- General.  Both  these 
men  have  left  works  behind  them,  showing  that  they 
were  far  in  advance  of  the  profession  of  their  time,  and 
were  preparing  the  way  for  the  great  scientific  dis- 
coveries of  a  later  age.  Blair's  account  of  the  yellow 
fever  epidemic  in  British  Guiana  between  the  years  1837 
and  1842  is  full  of  interest  and  well  repays  study, 
especially  in  the  light  of  modem  knowledge.  The 
reader  will  get  a  pictm-e  of  Water  Street,  Robb  Town, 
the  Stellings,  and  Eve  Leary  barracks,  and  the  mud- 
lots  in  1847,  which,  if  he  knows  the  Georgetown  of  to- 
day, with  its  60,000  inhabitants,  will  conmnce  him  that 
every  tropical  country,  whether  above  or  below  the  sea- 
level,  has  a  future,  and  one  which  is  all  the  more  easy  to- 
day to  accomplish,  seeing  that  we  know  exactly  how 
to  meet  disease.  In  my  opinion,  Demerara  should  be 
taken  as  the  example  of  what  can  be  done  in  the  tropics 


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by  intelligence  and  perseverance.     The  total  population 
of  British  Guiana  is  now  given  at  354,549. 

History  of  Yellow  Fever  in  recent  times. — Since  1888 
up  to  the  present  time,  there  appears  to  have  been  no 
cases  of  yellow  fever. 

Here,  therefore,  is  another  example  in  the  West 
Indies  of  the  disappearance  of  yellow  fever.  The  last 
large  epidemic  was  in  the  year  1881 ;  to  what,  then,  must 
we  ascribe  the  diminution  and  suppression  of  the  disease  ? 
In  this  particular  instance  we  cannot,  with  the  certainty 
that  we  did  in  the  case  of  the  other  islands,  refer  the 
immunity  to  the  water-supply ;  as  far  as  I  am  able  to 
ascertain,  a  partial  pipe-borne  water-supply  was  intro- 
duced in  the  forties ;  rain-water  has,  however,  continued 
to  be  the  chief  source  of  supply.  It  is  stored,  as  of  old, 
in  large  vats  or  in  barrels  and  other  receptacles.  We 
are  therefore  driven  to  seek  additional  causes  for  the 
yellow  fever  immunity  which  Georgetown  has  experi- 
enced during  the  last  decades.  Probably  the  explanation 
lies  in  far  stricter  quarantine  supervision,  better  housing, 
general  sanitation,  and  medical  organisation.  These 
factors  have  led  to  security  just  as  they  did  in  New 
Orleans  up  to  1905,  in  spite  of  the  fact  that  the  Stegomyia 
was  breeding  in  abundance  in  the  numerous  unscreened 
vats  and  barrels.  But  in  1905,  when  yellow  fever  had 
broken  out  widely  over  Central  America,  infection 
found  its  way  into  New  Orleans,  and  in  a  few  weeks 
that  city  was  face  to  face  with  a  great  epidemic.  This 
only  shows  that,  given  the  entrance  of  a  case  of  the 
disease  and  the  conditions  at  hand  for  its  spreading,  as 
for  example  the  presence  of  the  Stegomyia,  then  all  the 


232       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

other  sanitary  reforms  are  of  little  avail.  In  the  case 
of  Georgetown,  yellow  fever  has  fortunately  been  kept 
out,  but,  had  it  got  in,  it  would  have  found  the  Stegomyia 
in  abundance  ready  to  spread  it,  for  the  Stegomyia  was 
the  common  house-mosquito  of  Demerara. 

Stegomyia  Survey. — I  made  my  house-to-house  in- 
spection  in  company  with  the   Surgeon-General  and 
Mr  Luke  M.  Hill,  Town  Superintendent.     Altogether 
I  examined  33  lots  in  the  poorer  district  of  Georgetown  ; 
in  these  there  were  44  large  vats,  77  water-barrels,  42 
washing-tubs,  19  buckets,  5  jars,  and  7  kerosene  tins, 
and  in  addition,  small  odds  and  ends.     Practically  all 
the  barrels  and  a  considerable  proportion  of  the  other 
receptacles  contained  larvse  with  one  or  two  exceptions ; 
no  vats  had  been  screened,  as  at  the  time  of  my  visit 
screening  had  not  been  enforced.     It  was  interesting  to 
observe  the  immediate  effect  which  the  water-barrels  had 
in  favouring  the  development  of  the  Stegomyia — larvae 
were    invariably  present.      Some  of  the    yards    were 
waterlogged,  owing  to  their  low  level,   and  in  conse- 
quence looked   dirty.      But  in   my  opinion   the   most 
serious    disadvantage    under    which     the    inhabitants 
laboured  was  the  excess  of  bush  which  had  grown  up, 
and  which  gave  rise  to  a  vast  amount  of  litter  and  kept 
the  sun  and  fresh  air  out  and  the  yards  damp.     There  is 
a  very  great  disadvantage  in  allowing  bush  to  grow  up 
in  the  yards  in  town.     It  gives  cover  to  mosquitos,  and, 
as  many  of  the   plants   retain   water,   they   encourage 
breeding.     Worse  still,  the  litter  from  them  is  excellent 
cover  for  rats  and  fleas,  and  so  they  encourage  these  most 
dangerous  pests,  and  therefore  the  spreading  of  plague. 


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233 


when  once  introduced.  Moreover,  by  excluding  the 
fresh  air  and  contributing  to  the  general  dampness,  it 
encourages  tuberculosis.  I  am  therefore  convinced  that 
from  the  public  health  point  of  view  the  yards  should 
be  thoroughly  cleansed  of  all  bush  in  the  town. 
Ornamental  trees  along  the  roads  are  very  beautiful  and 
need  not  be  interfered  with,  provided  that  their  litter 
does  not  in  any  way  obstruct  the  side  drains  and 
trenches.  In  the  tropical  world,  wherever  there  is 
a  tendency  to  plague  or  mosquitos,  particular  attention 
must  be  directed  to  bush  clearing ;  it  is  rightly  regarded 
as  second  only  to  drainage  in  importance. 

On  22nd  April  I  visited  the  town  of  New  Amsterdam, 
Berbice.  I  made  a  tour  of  inspection  with  the  Mayor 
and  Town  Council,  Dr  J.  E.  Godfrey,  Dr  De  Freitas,  the 
sanitary  inspector,  and  the  Rev.  J.  Aitkin.  I  inspected  in 
Pitt  and  St  Ann  Streets  fifteen  yards  belonging  to  houses 
contained  in  two  lots.     In  these  fifteen  yards  I  found — 


Barrels 

40 

Vats 

8 

Tubs 

11 

Tins 

2 

Buckets 

5 

this  shows  that  there  is  a  vary  large  excess  of  barrels 
used  for  storing  water — chiefly  rain-water.  In  ten  out  of 
the  fifteen  yards  larvae  were  found  in  the  barrels,  and  the 
barrels  nearly  always  contained  larvse.  This  shows 
that  in  New  Amsterdam  the  barrels  almost  invariably 
contain  larvae,  and  this  is  the  experience  of  others.  The 
larvae  were  those  of  the  Stegomyia.  With  the  Rev.  J. 
Aitkin  I  examined  in  Stanley  Town  a  small  pond  in  a 


234       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

field  and  found  Anophelines;  he  assured  me  that  Ano- 
phelines,  were,  however,  not  to  be  found  in  the  ditches. 
On  26th  April  I  visited  the  Diamond  Sugar  Plantation,  in 
company  with  the  Surgeon- General  and  Dr  Law,  the 
medical  inspector  of  the  colony  :  there  were  many  barrels 
for  holding  the  domestic  water,  but  they  were  all  screened 
by  means  of  copper  gauze,  and  contained  no  larvse. 

The  Study  of  Entomology  in  British  Guiana. — 
Although  the  colony  possesses  no  official  entomologist, 
it  is  fortunate  in  possessing  medical  men  and  the 
Rev.  J.  Aitkin,  who  have  devoted  much  attention  to 
the  breeding  places  of  mosquitos.  Drs  Ozzard  and 
Rowland  and  Mr  Aitkin  have  contributed  much  to 
the  mapping-out  of  the  distribution  of  mosquitos  in 
the  colony.  Mr  Aitkin  has  been  good  enough  to 
furnish  me  with  the  following  memorandum  upon  the 
distribution  of  disease-carrying  mosquitos  in  the  New 
Amsterdam  district.^ 

Cellia  albipes  and  argyrotarsis. — The  former  is  the 
most  common  Anopheline  in  New  Amsterdam.  It  is 
found  in  ponds  and  in  smaller  collections  of  water  at  or 
near  the  ground-level,  and  in  all  manner  of  receptacles 
lying  on  the  ground,  such  as  tins,  calabashes,  etc.,  also  in 
water  in  tree  stumps  about  20  inches  from  the  ground. 
Not  found  as  yet  in  trenches,  vats,  open  iron  tanks,  nor 
in  drains  or  standpipe -pools.     Mr  Aitkin  adds  : — 

"I  have  made  extensive  observations  over  a  large 
area  of  the  colony,  from  Spira  Village,  about  100  miles 
up  Corentyne  River,  on   the   Eastern  boundary  of  the 

1  His  paper  on  the  mosquitos  of  British  Guiana  has  just  appeared 
in  the  British  Guiana  Medical  Aimual^  1909. 


MOSQUITOS  235 

colony,  at  points  on  the  coast  from  Skeldon  to  New 
Amsterdam;  in  Georgetown,  and  on  West  Coast, 
Demerara,  Chalkhill  Village,  and  Supenaam  Creek, 
Essequebo,  and  my  experience  of  the  absence  of 
Anopheline  larvae  has  been  repeated  without  exception. 

"  Stegomyia  calopus  is  found  in  vats,  barrels,  gobis, 
calabashes ;  refuse  ware  of  all  sorts ;  cisterns  supplying 
baths,  etc.,  those  with  pipe  projecting  an  inch  or  two 
above  the  bottom ;  especially  flower-glasses ;  buckets  (in 
houses  and  outside) ;  small  pools  beneath  houses ;  in  tree 
stumps  near  houses ;  iron  tanks  at  stables,  etc. ;  always 
in  clear  water. 

"  It  is  not  found  in  trenches,  nor  exceptionally  in  the 
large  iron  tanks  at  hospital.  New  Amsterdam,  though 
I  examined  carefully  the  matter  from  the  bottom  of  two 
of  these,  bucket  by  bucket,  as  the  tanks  were  being 
cleaned  out  on  one  occasion,  and  repeatedly  when 
tanks  were  full.  These  tanks  were  curiously  free  from 
culicid  larvse,  though  larvse  cases  of  various  gnats  were 
frequently  found  by  me  in  them. 

"  Culex  similis  and  fatigans  found  in  all  the  above 
places  and  also  in  foul  trench-water,  dirty  barrel-water, 
in  hollows  in  large  sandbox  trees,  and  in  ponds." 

As  the  colony  is  intersected  by  miles  of  fresh-water 
canals  and  trenches,  and  as  rice  is  now  being  cultivated, 
the  question  has  arisen  :  How  far  do  these  necessary 
large  collections  of  water  contribute  to  the  breeding  of 
mosquitos — more  especially,  of  course,  the  harmful  kinds? 
Mr  Aitkin,  from  his  experience,  states  as  follows  : — 

The  Trenches. — "As  noted  above,  my  varying  experi- 
ence of  trenches  has  been  failure  to  find  larvae  of  Anophe- 


236       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

Ihies  and  Stegomyia.  What  importance  they  might 
assume  were  other  breeding  places  barred,  I  cannot  of 
course  guess.  At  present  I  am  satisfied  they  are  not  a 
factor  in  the  problems  of  malarial  and  yellow  fever." 

"The  drainage  trenches  are  at  certain  seasons  the 
breeding  place  of  Culex  twniorhynchus  in  countless 
numbers,  and  other  culices  of  the  fatigans  type.  Fish  of 
the  '  millions'  variety  keep  the  clear,  fresh-water  trenches 
free  from  all  larvae,  and,  except  after  long  dry  weather, 
fry  of  mullet,  etc.,  abound  in  drainage  trenches  and 
keep  these  also  free  of  larvae.  A  little  care  and  no 
expense,  except  that  entailed  in  flushing  during  a  month 
to  six  weeks  annually,  would  probably  do  away  with 
the  mosquito  plague  in  New  Amsterdam,  which  gives 
the  town  its  reputation  as  a  mosquito-haunted  place, 
C.  twniorhynchus  has  of  course  not  been  identified  as  a 
disease-carrier,  but  I  have  felt  a  degree  of  physical 
disturbance  from  his  attacks  which  almost  amounted  to 
a  pathological  condition,  with  slight  rise  of  temperature 
and  sensation  of  tiredness.  This,  I  may  remark,  was 
after  some  fifty  minutes  exposure  in  a  boat  in  a  trench 
hedged  in  by  bush,  and  fortunately  narrow,  as  Mark 
Twain  said  about  the  smells  in  Constantinople,  for,  if 
the  trench  had  been  wider  it  might  have  held  more 
mosquitos." 

"As  previously  noted,  no  Anophelines  have  been  found 
in  vats  ;  Stegomyia  and  culicids  have  adopted  them,  but 
the  latter  only  resort  to  them  if  no  other  accommodation  is 
available.  Culices  of  the  fatigans  and  similis  type  seem 
greatly  to  prefer  any  open  water  vessel  partially  shaded 
to    the  covered    vat.      At    the   Manse   at    Anchlyne, 


BREEDING  PLACES  237 

however,  where,  by  the  way,  no  other  water  was  at 
the  time  available  except  in  the  trenches,  I  found 
numerous  iarvse  of  C.  cubensis  (allied  to  fatigans) 
in  the  vat  actually  beneath  the  house  as  well  as  in 
other  vats  in  the  yard.  In  my  vat  here,  there  are 
plenty  of  S.  fasciata  larvae,  but  no  other  species 
whatever." 

"  The  ponds  are  far  and  away  the  most  prolific  source 
of  malarial  mosquitos  in  New  Amsterdam  and  district. 
In  several  ponds  in  which  fish  of  the  '  millions '  type 
are  numerous,  repeated  examination  has  revealed  no 
larvae.  In  one  instance,  I  managed  to  get  Culeoc  larvae, 
but  on  frequent  occasions  before  and  after  I  failed  to 
find  them.  Where  no  fish  were  found,  larvae  of  various 
CulicincB  and  Anophelince  were  invariably  plentiful." 

In  view  of  the  above  and  other  observations,  it 
appears  that  the  trenches  and  canals  do  not  as  a  rule 
breed  Stegomyia  or  Anophelines.  This  is  no  doubt  due 
to  the  fish  which  are  present,  and  it  shows  that  in  a 
country  notorious  for  its  innumerable  waterways  and 
swamps  that  the  danger  fi?om  malaria  or  yellow  fever 
does  not  arise  from  them,  but  from  the  small  collections 
of  water  in  and  around  the  dwelling-places.  The  fish 
look  after  the  waterways,  and  it  is  the  imperative 
duty  of  the  sanitary  authority  to  assist  the  fish,  and  to 
look  to  the  vats  and  barrels — that  they  are  screened, 
and  that  there  are  no  odd  receptacles  in  the  yards  or 
small  pools  of  any  kind. 

Antimosquito  Measures. — An  examination  of  the 
various  reports  of  the  Surgeon-General,  and  of  the 
Town  Board,  as  well  as  the  original  scientific  papers 


238       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

which  have  appeared  in  the  British  Guiana  Medical 
Journal,  clearly  disclose  the  fact  that  the  medical  pro- 
fession and  the  Government  had  become  fully  alive  to 
the  importance  of  taking  action  against  the  mosquito. 
In  his  1901-2  report,  the  Surg  eon- General  urged  the 
necessity  of  adopting  the  various  antimalarial  measures 
which  had  at  that  time  been  advocated,  such  as  drainage, 
the  use  of  nets,  and  the  taking  of  quinine,  and  he  has 
repeatedly  urged  the  importance  of  drainage  (see 
Malaria).  In  February  1906,  Councillor  Wallbridge 
wrote  a  vigorous  memorandum  on  the  subject  of 
mosquitos  to  the  Town  Council,  pointing  out  that  it 
was  the  duty  of  the  Town  Council  to  act  now  that  the 
facts  had  been  proven.  He  stated :  "  Much  has  been 
done  in  Georgetown  in  the  direction  of  mosquito 
extermination,  and  the  Town  Superintendent  deserves 
great  credit  for  the  improvements  he  has  made,  which 
have  all  tended  towards  the  abolition  of  the  mosquitos, 
such  as  levelling  of  the  streets  and  grading,  filling  up 
street  puddles,  construction  of  well-graded  concrete 
drains,  the  frequent  collection  of  rubbish  and  its  destruc- 
tion, drainage  of  stagnant  water,  filling  up  of  stagnant 
pools,  removal  of  tins."  I  thoroughly  endorse  this 
statement :  much  has  been  done.  Dr  Wallbridge  then 
proceeds  to  point  out  how  the  householders  can  assist 
the  Town  Council  by  doing  some  antimosquito  work 
themselves.  He  also  makes  some  very  trite  remarks 
about  curtailing  the  size  of  the  canals  and  removing 
weeds,  and  the  trimming  of  the  edges,  stocking  them 
with  fish  where  necessary,  and  also  oiling  if  the  other 
means  fail ;  he  also  recommended  a  scheme  for  flushing. 


ANTIMOSQUITO  MEASURES  239 

A  drainage  committee  of  the  Town  Council  was  formed, 
and  they  suggested  in  their  report,  that  the  Council's 
efforts  should  continue  unabated,  not  only  insisting 
but  seeing  that  the  rubbish  in  the  yards  of  the  town 
are  removed  and  the  vats  and  the  other  receptacles  for 
drinking-water  properly  protected  by  gauze.  On 
8th  March  1909,  Dr  Wallbridge  wrote  :  "  The  practical 
point  is  that  the  Town  Council  are  responsible  for  the 
health  of  the  town,  and  they  are  not  doing  the  duty 
they  have  sworn  to  do,  so  long  as  they  are  not  doing 
all  they  can  do  to  exterminate  mosquitos  in  the  town." 

Mosquitos  are  like  tourists  :  if  they  do  not  find 
accommodation  in  the  town,  they  will  cease  to  stay 
there. 

Under  New  Ordinance  13  of  1907,  new  regulations 
were  made  enforcing  proper  drainage  of  lots  in  George- 
town. In  the  same  year,  mosquito  prevention  bye-laws 
were  also  introduced  to  compel  the  screening  of  all  vats 
and  other  vessels. 

They  were  not,  however,  enforced  until  this  year, 
when  very  vigorous  action  was  taken,  and  up  to  July 
some  1700  vats  were  screened  (see  Mosquito  Laws). 

I  have  now  brought  forward  evidence  to  show  that 
in  spite  of  most  serious  natural  difificulties,  British 
Guiana  has  done  a  great  deal  to  rid  itself  of  mosquito - 
borne  disease ;  of  course  a  great  deal  remains  to  be 
done  yet ;  but  as  the  various  authorities  have  done  so 
well  in  the  past,  there  is  not  much  fear  that  they  will 
depart  from  their  vigorous  and  commerce-promoting 
policy  of  waging  war  on  insect  pests. 

Malaria  and  its  Prevention  in  British  Guiana. — In 


240       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

1905,  His  Excellency  Sir  Frederic  Hodgson,  K.C.M.G., 
appointed  a  Commission  to  enquire  into  the  general 
mortality  of  the  colony,  which  was  very  high.  In  this 
report  the  cause  of  the  highest  mortality  is  stated  to  be 
malaria. 

Thus  the  deaths  from  malarial  fever  in 

1904  .  .  .  were  212 

1905  .  .  .  „   206 

1906  .  .  .  „   273 

1907  .  .  .  „   301 

The  monthly  returns  from  the  various  hospitals  in 
the  colony  gave  the  total  number  of  cases  of  malaria  as 
2387,  and  deaths  as  74,  and  if  to  these  we  add  all  the 
diseases  directly  and  indirectly  influenced  by  the 
cachexia  and  anaemia  produced  by  malaria,  there  can  be 
no  doubt  that  malaria  is  the  principal  disease  of  the 
colony. 

So  impressed  was  the  Commission  with  these  figures, 
that  it  recommended  that  steps  should  be  taken  against 
mosquitos,  as  follows  : — 

Arrangements  have  been  made  for  the  sale  of 
quinine  at  the  district  post-offices,  so  as  to  place  it 
within  reach  of  the  poorer  classes.  The  drug  is  retailed 
at  the  rate  of  2  cents  for  30  grains,  and  meets  with  a 
ready  sale.  It  is  only  intended  for  the  benefit  of  the 
people,  and  in  order  to  prevent  as  far  as  possible  its 
purchase  and  subsequent  resale  at  a  profit,  the  quantity 
which  can  be  sold  to  any  one  person,  at  a  time,  has 
been  limited  to  180  grains.  Later  on,  as  a  further 
precaution,  the  supplies  for  this  purpose  were  ordered  in 
tablet  form,  coloured  pink,  and  stamped  with  the  letters 


§  > 

H  'A 

y  P 

A  O 

^  O 

I  ^ 

o  o 

-Jl 

<! 


OBJECTIONS  TO  SCREENING  241 

"B.  G."  Drainage  operations,  fish-stocking,  removal 
of  receptacles,  and  screening  were  also  pushed  forward. 

Objections  to  Screening  Measures. — A  curious  idea 
was  at  one  time  prevalent  in  Georgetown — namely,  that 
as  mosquito  larvse  were  said  to  be  scavengers,  their  pres- 
ence in  the  vats  was  therefore  useful.  People  argued  : 
Why  screen,  if  the  larvae  may  remove  harmful  bacteria 
from  the  water  ?  I  have  heard  a  similar  argument  used 
in  British  Honduras  by  the  natives,  who  alleged  that  the 
presence  of  larvse  in  water  indicated  that  it  was  clean. 
In  a  certain  sense  this  latter  statement  is  true,  as 
Stegomyia  larvae  prefer  clean  water  to  dirty  water,  and 
hence  are  found  usually  in  the  drinking-water  and  not 
in  the  gutter- water.  But  on  the  other  hand,  we  have  no 
evidence  whatever  that  larvae  remove  pathogenic  bacteria 
from  water. ^  The  normal  diet  of  larvae  consists  of  green 
algae.  But  apart  altogether  from  what  is  or  what  is  not 
the  food  of  larvae,  it  is  obvious  that  no  one  in  their 
senses  would  trust  to  larvae  to  remove  from  water  the 
germs,  either  of  cholera,  or  typhoid,  or  dysentery,  and 
as  we  know  the  positive  harm  larvae  do  when  they 
become  mosquitos,  reason  will,  I  feel  sure,  dictate  that 
mosquitos  should  be  prevented  from  breeding  in  water. 

Education  as  a  Prophylactic  Factor  in  British 
Guiana.— The  Mortality  Commission's  report  referred  to 
the  importance  of  educating  the  public. 

This  has  been  acted  upon :  mosquito  cards  were 
prepared  by  Dr  "Wise,  the  Government  bacteriologist, 

1  I  have  made  a  series  of  experiments  which  show  that  the 
presence  of  larvae  adds  very  considerably  to  the  number  of  bacteria 
present. 

Q 


242       HEALTH  PROGRESS  IN  BRITISH  GUIANA 


under  the  direction  of  the  Surgeon- General,  and  these 
were  distributed  by  the  sanitary  staff  of  Georgetown ; 
in  the  same  way,  cards  deahng  with  baby -feeding  and 
tuberculosis  were  likewise  distributed.  The  press  of 
the  colony  has  also  done  its  share  in  educating  the 
public :  so  that,  all  told,  the  public  are  in  a  position 
to-day  to  realise  the  advantage  to  be  reaped  by  modern 
sanitary  reform,  and  especially  that  branch  of  it  which 
is  directed  against  insect  pests. 

Mortality  Returns. — As  already  stated,  the  Governor 
appointed  a  Commission  in  1905,  to  enquire  into  the 
general  mortality  of  the  colony. 

The  cause  of  highest  mortality  is  stated  to  be 
malaria. 

The  death-rate  for  Georgetown  is  high,  and  appears 
to  be  40  per  thousand. 

There  is  a  very  high  infant  mortality. 

The  principal  diseases  which  give  rise  to  the  great 
mortality  amongst  adults  and  infants  is  stated  to  be  : — 
Malarial  and  filarial  diseases ; 
Malaria  in  the  country  districts  ;  and 
Filaria  in  Georgetown. 
It  is   recommended,   therefore,    that    steps   should   be 
taken  against  mosquitos,  which  are  the  proved  carriers 
of  malaria,  yellow  fever,  and  filaria. 

Death-rate  per  1000. 

(Georgetown  and  Environs,  exclusive  of  country  patients  in  hospital.) 


1894   . 

.  46-3 

1899   . 

.  44-8 

1895   . 

.  42-7 

1900   . 

.  39-2 

1896   . 

.  36-8 

1901   . 

.  34-2 

1897   . 

.  38-1 

1902   . 

.  41-3 

1898   . 

.  43-1 

1903   . 

.  44-1 

DISEASE  RETURNS  243 

Deaths  from  1904.  1905.  1906.  1907- 

Ankylostomiasis 
Anaemia 
Malarial  fevers 
Phthisis  and  other  forms 
of  tuberculosis  . 


212         206         273         301 

365         287         296        272 


Monthly  Return  of  Diseases  and  Deaths  in  1907-8  at 
the  following  Institutions  : — Georgetown  Hospital^ 
Berhice  Hospital,  Suddie  Hospital,  Bartica  Hospital^ 
and  North- Western  District  (Morawhanna  and 
Arakaka). 


Diseases. 

Malarial  fevers    . 
Syphilis 

Blackwater  fever 
Ankylostomiasis 

Total 


Cases. 

Deaths 

2387 

74 

269 

34 

1 

1 

1 

0 

2658  109 


Ankylostomiasis. — The  Commissioners  stated  that 
they  regarded  this  disease  as  a  most  potent  cause  of  ill- 
health  amongst  the  coolies  and  also  amongst  the  black 
and  coloured  population  of  the  villages;  39,000  cases 
have  been  treated  in  the  estates  hospitals  during  the 
last  four  years.  The  Commissioners  also  stated  that  it 
was  indirectly  a  common  cause  of  the  high  mortality : 
for,  like  malaria,  it  caused  anaemia,  and  this  condition 
had  a  very  pernicious  effect  upon  nursing  mothers,  and 
therefore  contributed  indirectly  to  infant  mortality;  it 
also  increased  the  gravity  of  diseases  Hke  tuberculosis 
or  malaria.  They  recommended  that  efforts  should  be 
steadily  made  to  combat  the  disease  on  the  plantations 
and  also  in  the  villages,  as  it  appeared  that  it  was  on 
the  increase.  They  regarded  the  prospects  of  curative 
and  preventive  measures  very  hopefully. 


244       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

The  Surgeon-General  took  vigorous  action,  and  wrote 
a  memorandum  upon  the  subject  to  the  Colonial  Secre- 
tary of  British  Guiana.  This  was  followed  by  circulars 
to  all  Government  medical  officers  and  to  managers 
and  attorneys  of  sugar  estates  (see  Appendix).  The 
circulars  point  out  the  necessity  of  accurate  returns  based 
upon  systematic  microscopic  examination  of  the  faeces 
and  proper  latrine  accommodation.  A  circular  was  also 
issued  by  the  Colonial  Secretary  drawing  attention  to 
the  importance  of  suitable  latrine  accommodation  and 
the  prevention  of  defecation  in  the  cane-fields  (see 
Appendix  for  text  of  circulars).  I  visited  one  of  the 
large  sugar  estates  in  the  colony,  known  as  Diamond. 
I  went  in  company  with  Dr  Law,  who  is  the  medical 
inspector  of  the  colony,  and  travels  round  and  inspects 
estates  hospitals  and  reports  to  the  Surgeon-General. 
An  estate  is  supervised  by  a  manager,  under  whom 
are  overseers.  Under  these  again  are  drivers,  who 
look  after  the  various  gangs  of  labourers  employed  upon 
the  estate.  I  inspected  some  estates  hospitals  and  found 
the  arrangements  very  good.  I  also  examined  several 
of  the  "ranges."  They  were  particularly  clean  and 
well-ventilated,  and,  as  remarked  elsewhere,  the  water- 
barrels  were  properly  screened.  On  one  estate  there 
was  good  latrine  accommodation  for  both  males  and 
females ;  I  found  the  latrines  very  clean. 

The  question  of  latrine  accommodation  is  now 
engaging  the  serious  attention  of  the  health  authority 
of  the  colony,  and  there  is  little  doubt  that  an  efiPective 
system  will  soon  be  in  operation  on  all  the  estates,  and 
then  it  is  to  be  hoped  that  similar  arrangements  of  a  suit- 


OTHER  DISEASES  245 

able  natui'e  will  be  made  for  the  free  labourers  in  the 
villages,  so  that  this  abominable  labour-paralyzing  and 
mortality-increasing  disease  may  be  overcome.  In  order 
to  demonstrate  the  seriousness  of  this  disease,  I  reproduce 
on  p.  246  a  table  fi'om  the  Surgeon-General's  report. 

After  Malaria  and  Ankylostomiasis  come  tubercular 
affections.  These  are  prevalent,  and  are  due  to  causes 
into  which  I  have  already  gone,  such  as  overcrowding 
and  bad  ventilation.  The  Government  has  actively 
taken  up  the  matter  by  means  of  leaflets,  trying  to 
instruct  the  poorer  classes.  In  my  opinion,  increased 
drainage  operations  and  bush-cutting  in  the  villages  and 
towns  will  have  a  very  beneficial  effect. 

Leprosy. — I  visited  the  Leper  Hospital,  and  was 
much  gratified  to  find  for  the  first  time  in  my  tour  that 
an  endeavour  had  been  made  to  make  original  investiga- 
tions, and  to  try  new  methods  of  treatment.  Professor 
Deycke  had  made  very  numerous  observations  upon  his 
new  treatment  with  nastin. 

Would  that  more  investigators  like  Deycke  could  be 
induced  to  visit  these  magnificent  colonial  medical 
institutions  for  the  purpose  of  investigation  and  research. 
No  Empire  gives  such  opportunities  as  the  British. 

The  Colonial  Hospital.  —  On  11th  April  I  visited 
the  Colonial  Hospital  with  Dr  Godfrey.  There  are  500 
beds ;  the  hospital  is  beautifully  organised  and  equipped. 
There  is  a  pathological  department  with  bacteriological 
laboratory  and  commencing  library.  Dr  Wise  is  the 
bacteriologist,  and  steps  are  now  being  taken  to  appoint 
an  assistant  bacteriologist. 

Sanitary  Administration. — The  Surgeon- General  is 


246       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

Table  showing  the  Number  of  Cases  of  Anchylostoma 
Infection  on  the  different  Sugar  Estates  from  June 
1904. 


Name  of  Estates. 


No.  of  Cases 
previously 
treated  to 

January  1909. 


February 
1909. 


No.  of  Cases 

to 

February  1909. 


Skeldon 

Springlands . 

Port  Jlouraut 

Albion  . 

Adelphia 

Kose  HaU     . 

Mara     . 

Ma  Eetraite 

Friends 

Everton 

Providence  . 

Blairmont    . 

Batb     . 

Cane  Grove  . 

Melville 

Cove  &  John 

Hope    . 

Enmcre 

Non  Pareil  . 

Lusignan 

Mon  Hepos  . 

La  Boiine  Intention 

Success  (Dem.)     . 

Vryheid's  Lust    . 

Ogle      . 

Diamond 

Farm    . 

Providence  (Dem.) 

Peter's  HaU 

Houston 

Wales    . 

Nismes 

Schoon  Ord  . 

Versailles 

Vreed-en-Hoop    . 

Windsor  Forest  . 

Cornelia  Ida 

Leonora 

Uitvlugt 

De  Kinderen 

Tuschen 

Vergenoegen 

Golden  Fleece 

Taymoutb  Manor 

Anna  Eegina 

Hampton  Court  . 

MarionviUe  . 

Success  (Ess.) 

Totals 


266 

123 

255 

523 

169 

246 

365 

249 

1,790 

580 

357 

1,823 

180 

3,756 

2,080 

1,691 

2,164 

1,739 

2,624 

577 

312 

228 

689 

49 

1,157 

3,946 

1,708 

2,303 

1,048 

559 

4,059 

971 

181 

1,259 

64 

214 

113 

466 

460 

268 

19 

60 

628 

1,360 

1,167 

2,282 

1,572 

81 


2 

Nil 


6 
Nil 
Nil 


1 

37 

5 
49 
12 

9 
43 
23 

1 
17 
15 
10 

1 
NU 

S 
68 
55 
20 

ii 

31 
23 

NU 
18 


4 

18 

7 

1 

NU 

NU 

5 

8 

27 

13 

19 


268 

123 

258 

525 

169 

252 

365 

249 

1,798 

580 

358 

1.860 

185 

3,805 

2,092 

1,700 

2,207 

1,762 

2,625 

594 

327 

238 

090 

49 

1.165 

4,014 

1.763 

2,323 

1.04S 

'576 

4,090 

994 

181 

1,277 

64 

214 

117 

484 

467 

269 

19 

60 

633 

1,368 

1,194 

2,295 

1,591 

81 


49,366 


MEDICAL  ADMINISTRATION  247 

the  medical  head  of  the  colony.  There  is  also  on  his 
staff,  as  we  have  seen,  a  medical  superintendent  for  the 
colony  charged  with  the  inspection  of  estates  hospitals, 
and  there  is  also  a  Government  bacteriologist  and 
various  district  medical  officers.  Georgetown,  the 
capital  of  the  colony,  has  a  mayor  and  town  council, 
and  they  have  the  services  of  a  town  superintendent 
and  a  medical  officer  of  health.  But  as  the  whole 
services  of  this  gentleman  are  not  devoted  to  municipal 
and  port  sanitation,  correspondence  took  place  in  1908 
in  order  to  bring  about  the  appointment  of  a  medical 
officer  of  health  for  the  city  of  Georgetown,  its  port  and 
environs,  whose  whole  time  should  be  devoted  to  his 
public  duties.  To  my  mind,  there  can  be  little  doubt 
that  such  a  step  would  be  a  very  wise  and  useful  one, 
and  would  bring  the  sanitary  administration  of  George- 
town and  of  its  port  in  direct  touch  with  the  medical 
head  of  the  colony,  and  for  sanitary  progress  and 
organisation  this  is  most  essential. 

Quarantine  Administration.  —  So  far,  plague  and 
yellow  fever  have  been  kept  out.  As  an  example  of 
the  trouble  to  which  the  want  of  medical  co-ordination 
in  Barbados  put  British  Guiana,  as  well  as  the  other 
colonies  to  which  I  have  already  referred  in  previous 
chapters,  I  quote  the  following  correspondence : — 

Tardy  Notification  of  Barbados  re  Yellow  Fever. 

The  Honourable 

The  Government  Secretary, 

I  think   the   Barbados    Government 
should  have  notified  us  earlier ;  we  received  the  informa- 


248       HEALTH  PROGRESS  IN  BRITISH  GUIANA 

tion  ten  days  after  the  case  occurred  and  three  days 
after  the  death  of  the  person. 

2.  I  trust  there  will  be  a  meeting  of  the  quarantine 
authority  at  an  early  date,  as  there  are,  in  my  opinion, 
several  matters  that  require  to  be  dealt  with  : — 

(a)  The    extension   to    thirty   days    of    quarantine 
restrictions  with  regard  to  yellow  fever ; 

{b)  A  place  to  be  declared  infected  on  the  occurrence 
of  one  case  of  yellow  fever. 

J.  E.  Godfrey, 

Surgeon-General. 
2lst  April  1908. 

The  Government  Secretary,  Mr  C.  T.  Cox,  then  wrote 
the  Government  Secretary  at  Barbados,  as  follows  : — 

With  reference  to  your  telegram  of  the  16th  ultimo, 
reporting  the  occurrence  of  a  fresh  case  of  yellow  fever 
in  Barbados,  and  to  your  circular  letter  No.  5  of  the 
same  date  forwarding  the  medical  report  on  the  case, 
I  am  directed  by  the  Governor  to  invite  your  attention 
to  the  time  which  elapsed  between  the  occurrence  and 
notification  of  this  case,  and  to  express  the  hope  that 
every  effort  will  be  made  to  avoid  such  delay  if  any 
other  cases  should  unfortunately  occur. 

The  answer  received  was  as  follows  : — 

1.  With  reference  to  the  recent  cases  of  yellow 
fever  that  have  been  notified  to  you  as  having  occurred 
in  the  parish  of  St  Lucy  in  this  island,  I  am  directed  to 
inform  you  that  in  consequence  of  rumours  as  to  the 
prevalence  of  sickness  in  that  parish  the  board  of  health 
sent  down  a  special  representative  to  investigate  and 
report. 

2.  Dr  Hutson,  the  officer  selected,  himself  a  member 
of  the  board  of  health,  visited  the  parish,  and  after  an 
exhausting  enquiry  made  the  report  which  is  enclosed 
herewith. 


COMPLAINTS  AGAINST  BARBADOS  249 

3.  Although  it  is  not  possible  to  report  as  yellow 
fever  cases  which  were  not  recognised  as  such  by  the 
doctor  attending,  and  which  were  not  seen  by  Dr 
Hutson,  it  has  been  considered  desirable  to  inform 
all  parties  to  the  convention  of  the  exact  facts  which 
have  come  to  the  knowledge  of  the  Government,  and  of 
the  measures  which  have  been  taken  for  the  stricter 
surveillance  and  sanitation  of  the  parish  of  St  Lucy, 
and  which  are  enumerated  in  the  body  of  the  report. 

4.  In  this  connection  I  am  to  add  that  His 
Excellency  regrets  that  there  should  have  been  delay 
in  notifying  certain  cases  of  yellow  fever.  In  no 
instance  has  any  delay  occurred  when  once  a  case  of 
yellow  fever  has  been  reported  to  the  health  authorities  ; 
but  it  has  unfortunately  occurred  that  the  doctors 
attending  a  case  have  not  always  been  able  to  agree 
upon  their  diagnosis  until  after  several  days'  observation, 
and  in  one  case  until  some  days  after  the  man's  death. 
In  view  of  the  measures  now  adopted,  it  is  not  likely 
that  any  further  delay  will  be  due  to  this  cause. 

It  will  be  observed  that  the  board  of  health,  having 
no  principal  medical  officer,  sends  down  a  member  of 
their  own  board  to  investigate  and  report.  In  other 
words,  they  make  Dr  Hutson  for  the  time  being  their 
honorary  medical  officer  of  health,  and  then,  owing  to 
their  lack  of  medical  organisation,  the  extraordinary 
statement  is  made  contained  in  the  last  paragraph. 


APPENDICES 


APPENDIX  A 

CIRCULARS  AND  REPORTS  RELATING  TO  ANKYLO- 
STOMIASIS IN  BRITISH  GUIANA  AND  IN  THE 
WEST  INDIES 

Circular  issued  by  the  Surgeon-  General. 

Suegeon-Genekal's  Office, 
Georgetown, 

\Uh  December  1901. 

Sir, 

The  existence  of  ankylostomiasis  in  this  colony 
was  first  brought  prominently  to  the  notice  of  Government 
medical  ofi&cers  by  the  late  Surgeon-General  (Dr  Grieve)  in  a 
Circular  Letter,  No.  14,  dated  the  2nd  February  1888. 

2.  Since  then  it  has  been  proved  that  the  disease  exists  in 
every  part  of  the  colony,  and  is  extending  to  an  alarming  extent. 

3.  The  mortality  returns  directly  attributable  to  this  disease 
are  small,  but  it  is  open  to  grave  doubts  whether  some  deaths 
at  present  attributed  to  other  diseases  would  not  be  more 
correctly  returned  as  due  to  ankylostomiasis.  Whether  this 
be  so  or  not,  of  one  point  I  think  we  may  be  sure,  and  that  is : 
the  existence  of  this  disease  is  the  source  of  the  loss  of  a 
considerable  amount  of  labour  on  sugar  estates ;  hence  it  is  most 
important  for  the  employers  of  labour  that  these  cases  be 
correctly  diagnosed  and  treated  in  the  early  stages ;  they  could 
then  be  rapidly  restored  to  health  and  become  useful  labourers, 
whereas,  if  neglected,  they  steadily  become  more  and  more 
debilitated,  and  ultimately  become  hopeless  invalids  fit  only  for 
the  Alms  House. 

253 


254  APPENDIX   A 

4.  As  the  disease  is  a  preventable  one,  and  eminently  curable 
when  treated  in  the  early  stages,  it  is  our  bounden  duty  to  do 
everything  in  our  pov^er,  not  only  to  cure  individual  cases,  but 
to  endeavour  by  all  means  to  stamp  it  out. 

5.  With  this  in  view,  therefore,  I  take  the  opportunity  of 
bringing  the  matter  again  before  your  notice  and  of  asking  your 
hearty  co-operation. 

In  order  to  facilitate  the  work,  I  beg  to  make  the  following 
suggestions : — 

(a)  The  chief  indication  of  ankylostomiasis  is  anaemia,  with 
its  attendant  symptoms. 

(6)  After  the  removal  of  the  parasites,  this  anaemia  usually 
disappears  rapidly,  even  without  further  treatment. 

(c)  To  diagnose  ankylostomiasis  with  accuracy,  especially 
in  its  early  stages,  it  is  necessary  to  make  a  micro- 
scopic examination  of  the  stools,  in  order  to  search 
for  the  ova.  This  is  a  most  simple  matter,  requiring 
only  an  ordinary  student's  microscope  with  a  magnify- 
ing power  of  not  more  than  150  to  200  diameters. 
The  dispensers  at  the  estates  hospitals  can  easily  be 
taught  to  prepare  and  have  in  readiness  for  you 
specimens  of  faeces  of  suspected  cases. 

{d)  This  is  quickly  done  by  placing  a  very  small  quantity 
of  faeces  on  a  slide,  adding  a  little  water  if  required, 
dropping  the  cover-glass  on  it  and  gently  pressing  it 
down.  A  ring  of  vaseline  may  then,  if  necessary,  be 
put  round  the  cover  glass  to  prevent  evaporation. 

{e)  Having  found  the  ova  (an  excellent  plate  description 
of  it  is  to  be  found  in  Davidson's  work,  Diseases  of 
Warm  Climates),  the  next  step  is  to  expel  the 
parasite,  and  the  following  is  the  usual  course 
adopted : — 

Place  the  patient  for  a  couple  of  days  or  so  on 
"milk"  or  "spoon"  diet,  giving  an  alkaline  bitter 
mixture  to  remove  mucus.  Then  the  night  before  the 
thymol  is  given,  a  dose  of  calomel   is  administered. 


APPENDIX   A  255 

and  on  the  following  morning  60  to  75  grains  of 
thymol,  divided  into  three  doses — say,  at  6  A.M.,  7 
A.M.,  and  8  a.m.,  and  followed  at  noon  by  a  full  dose 
of  castor  oil.  Thymol  is  best  given  in  cachets  or 
wafer  papers. 

(/)  All  stools  passed  for  48  hours  after  administration 
of  thymol  should  be  carefully  washed  through 
muslin.  This  is  done  as  follows:  A  good-sized  hoop 
is  made  (a  hoop  from  a  flour  barrel  answers 
admirably),  and  muslin  or  very  fine  netting  stretched 
over  it.  The  faeces  are  then  placed  on  this,  which  is 
held  over  a  bucket  and  a  stream  of  water  kept  gently 
flowing  on  them  until  practically  all  the  faeces  are 
washed  away,  when  the  worms  are  easily  found  and 
counted.  This  process  can  with  a  little  teaching  be 
done  by  the  dispenser. 

(g)  The  patient  should  then  be  placed  on  tonic  treatment, 
and  at  the  end  of  a  week  or  so  the  stools  again 
examined,  and,  if  ova  are  found,  the  thymol  treatment 
repeated. 

6.  As  it  has  been  found  from  experience  that  new  immigrants 
frequently  bring  this  disease  with  them,  or  acquire  it  very  shortly 
after  landing  here,  particular  care  should  be  taken  to  examine 
each  at  the  monthly  inspections  for  symptoms  of  this  disease,  and 
any  found  to  be  suffering  from  anaemia  should  be  at  once  placed 
under  observation. 

7.  It  will  be  noticed  that  the  apparatus  necessary  for  the 
detection  of  these  parasites  and  their  ova  is  extremely  simple,  the 
principal  and  most  expensive  item  being  a  microscope  with  the 
necessary  glass  slides  and  cover-glasses.  I  therefore  appeal  to  the 
estates  authorities  for  their  assistance  and  co-operation.  This 
can  best  be  given  by  supplying  each  hospital  with  a  microscope, 
the  cost  of  which  should  not  exceed  thirty  dollars.  I  shall  be 
pleased  at  any  time  to  recommend  or  advise  as  to  the  sort  of 
microscope  that  would  be  suitable. — I  have,  &c., 

J.  E.  Godfrey, 

Acting  Surgeon-General. 


256  APPENDIX  A 

Circular  to  all  Government  Medical  Officers  and 
Managers  and  Attorneys  of  Sugar  Estates. 

Shegeon-Geneeal's  Office, 

Georgetown,  2th  May  1902. 

/.  Ankylostomiasis. 
II.  Monthly  return  of  cases  treated  for  Intestinal  Parasites. 

Sm, 

Eeferring  to  my  Circular  No.  240,  dated  the  14th 
December  1901,  I  have  the  honour  to  attach  for  your  guidance  a 
"  form/'  which  is  to  be  regularly  filled  up  and  transmitted  to  me 
at  the  end  of  each  month. 

2.  In  making  the  microscopic  examination  of  the  faeces,  you 
will  take  particular  care  to  search  for  the  ova  of  the  three  most 
common  species  of  nematode  worms  found  in  the  colony,  viz., 
Ascaris  lunibricoides,  Trichocephalus  dispar,  Ankylostomum 
duodenale. 

3.  A  description  of  this  will  be  found  in  Manson's  book  on 
tropical  diseases. 

4.  With  regard  to  the  purgative  to  be  used  in  the  case  of 
ankylostomiasis,  it  has  been  found  advisable  to  use  salines 
instead  of  oil,  as  thymol  is  to  a  certain  extent  soluble  in  ;i  oils, 
and  toxic  symptoms  might  follow  due  to  absorption  ;  for  the  same 
reason  alcohol  should  o?i  no  account  be  given  during  the  thymol 
treatment. 

5.  It  is  essential,  in  order  to  have  the  number  of  cases  of 
ankylostomiasis  properly  returned,  that  every  case  should  be 
diagnosed ;  and  I  must  again  impress  on  you  the  necessity  of 
examining  the  stools  of  all  cases  of  anaemia. 

6.  It  is  well  to  remember  that  in  the  cases  of  Anhylostomum 
duodenale  the  stools  should  be  examined  shortly  after  they  have 
been  passed,  otherwise  the  ova  develop  rapidly,  and,  the  embryo 
having  quitted  the  shell,  the  egg  is  no  longer  visible. 


APPENDIX   A  257 

7.  With  regard  to  the  form  under  the  heading  "  Eesult  of 
Microscopic  Examination,"  you  will  state  the  variety  of  ova  of 
nematode  worm  found  ;  if  none,  enter  "  nil." 

8.  The  faeces  should  be  washed  to  search  for  the  mature 
worms  from  time  to  time,  and  the  result  entered  in  the  proper 
column. 

9.  Under  the  heading  "  Eemarks/'  give  anything  of  interest. 

I  have,  &e., 

J.  E.  Godfrey, 

Activig  Surgeon-General. 


Examination  of  Newly  Allotted  Immigrants  for 
Ankylostomes. 

SiK, 

I  have  the  honour  to  direct  that  in  future  you  will 
make  a  microscopic  examination  of  the  stools  of  every  newly 
allotted  immigrant  on  his  or  her  arrival  on  the  estate,  so  as  to 
ascertain  the  presence  or  otherwise  of  ankylostomes. 

2.  This  examination  should  be  carried  out  with  despatch,  and  in 
batches,  so  as  to  cause  as  little  inconvenience  as  possible  to  the 
estates. 

3.  You  will  send  the  results  of  your  examinations  to  me, 

4.  Please  acknowledge  receipt,  and  file. 

I  have  the  honour  to  be. 
Sir, 
Your  obedient  Servant, 

J.   E.   GODFEEY, 

Surgeon-GeTberal. 

To  all  District  Government  Medical  Officers. 


258  APPENDIX   A 


Circular  No.  2708 — British  Guiana. 

Government  Secretary's  Office, 
Georgetown,  Demeraea, 

24«/i  July  1908. 


SlE, 


I  am  directed  by  the  Governor  to  inform  you  that 
in  connection  with  the  efforts  which  have  been  made  by  the 
Government  to  stamp  out  ankylostome  infection  among  East 
Indian  immigrants,  it  has  been  found  that  upon  those  sugar 
estates  where  suitable  latrine  accommodation  has  been  provided, 
and  where  efforts  have  been  made  to  prevent  the  resident  popula- 
tion from  defecating  elsewhere,  there  has  been  a  marked  improve- 
ment in  health  conditions. 

2.  The  Secretary  of  State  for  the  Colonies  has,  under  the 
circumstances,  suggested  for  consideration  that  in  order  to  make 
these  arrangements  universal,  and  thus  to  lessen  the  risk  of 
ankylostome  infection  to  the  general  labouring  population  of  the 
colony,  the  allotment  of  new  immigrants  to  an  estate  should  be 
dependent  upon  its  being  made  clear  that  proper  latrine 
accommodation  has  been  provided. 

3.  The  matter  has  been  considered  by  the  Governor  in  Council, 
and  I  am  to  inform  you  that  having  regard  to  the  importance  of 
combating  ankylostome  infection,  it  was  considered  very  desirable 
that  the  suggestion  should  be  adopted.  I  am  therefore  to  inform 
you  that,  while  no  immediate  action  will  be  taken  to  give  effect 
to  it,  as  the  allotment  of  immigrants  during  the  current  year  has 
already  been  approved,  the  question  will  necessarily  come  before 
the  Governor  in  Council  when  the  applications  for  next  year's 
allotments  are  received,  and  His  Excellency  trusts  that  if  you 
should  apply  for  immigrants  next  year  you  will  be  in  a  pog-'tion 
to  state  that  suitable  latrine  accommodation  has  been  provided. 

I  have  the  honour  to  be. 
Sir, 
Your  obedient  Servant, 

Charles  T.  Cox, 

Government  Secretary. 
To  Employers  of  Coolie  Labour. 


APPENDIX   A  259 


Sir, 

Your  attention  has  several  times  ^  been  called  to  the 
prevalence  of  anaemia  among  the  labourers  (indentured  immigrants 
and  others)  employed  on  the  sugar  estates,  and  in  the  circulars 
noted  in  the  footnote  special  reference  has  been  made  to 
ankylostomiasis  as  the  principal  cause  of  it. 

2.  The  Governor,  who  has  had  this  matter  under  his  attention, 
is  glad  to  notice  that  in  the  case  of  some  districts  the  medical 
officers  have  carefully  carried  out  their  instructions  for  discovering 
and  treating  ankylostoma  infection.  But  in  others,  although 
the  conditions  are  more  or  less  identical,  nothing,  or  practically 
nothing,  has  been  done. 

3.  The  loss  of  work  on  estates  due  to  anaemic  labourers  is  at 
times  very  severely  felt,  and  I  am  to  acquaint  you  that  His 
Excellency  is  determined  that  every  possible  effort  shall  be  made 
to  prevent  any  further  loss  of  labour  from  ankylostoma  infection 
or  any  other  preventable  cause.  He  expects  that  every  Govern- 
ment medical  officer  will  co-operate  in  the  work  of  stamping  out, 
or  at  any  rate  reducing,  diseases  of  that  character,  and  he  trusts 
that  henceforward  those  medical  officers  who  have  not  hitherto 
attached  importance  to  the  disease  of  ankylostomiasis  will  do  so 
in  future,  and  that  it  will  not  be  necessary  to  send  further 
circulars  and  reminders. 

4.  The  Governor's  direction  is  that  every  immigrant,  whether 
free  or  indentured,  and  every  labourer  who  may  be  brought  before 
you  suffering  from  anaemia  or  showing  any  symptoms  suggestive 
of  the  presence  of  ankylostomes,  shall  be  dealt  with  in  accordance 
with  the  instructions  in  your  hands ;  and  he  desires  it  to  be 
known  that  any  officer  who  disregards  this  plain  direction,  will 
incur  grave  responsibility  as  regards  the  health  of  the  labouring 
population,  and,  incidentally,  the  consequences  which  result  from 
neglect  to  carry  out  an  official  order. 

1  No.  14,  of  2nd  Feb.  1888  ;  No.  240,  of  14th  Dec.  1901  ;  No.  249,  of  9th 
May  1902 ;  No.  345,  of  8th  July  1904 ;  No.  357,  of  26tli  Oct.  1904. 


260  APPENDIX   A 

5.  It  will,  I  am  to  add,  be  one  of  the  duties  of  the  medical 
inspector  to  see  that  these  orders  are  henceforward  carefully 
observed  and  to  make  a  report  to  me  when  there  has  been 
failure,  which  report  will,  in  every  instance,  be  submitted  to 
the  Governor. 

I  am.  Sir, 

Your  obedient  Servant, 

J.  E.  Godfrey, 
Surgeon-GeTieral,  Georgetown. 
5th  Novemher  1904. 

N.B. — Please  acknowledge  receipt,  and  file. 

To  all  Government  Medical  Ofi&cers. 


Correspondence  with  regard  to  the  prevention  of  Ankylos- 
tomiasis in  British  Guiana  and  other  Colonies,  1909. 

SUMMAEY   OF  THE   EePORTS   RECEIVED   FROM   THE   WeST   INDIAN 

Colonies  on  the  Subject  of  Ankylostomiasis. 

Bahamas. — In  this  colony  the  disease  is  said  to  be  practically 
unknown. 

Bermuda. — This  colony  is  also  said  to  be  free. 

British  Guiana. — The  disease  is  very  prevalent,  no  less  than 
39,000  cases  having  been  treated  in  the  estates  hospitals  in  the 
last  four  years.  There  are  no  special  sanitary  measures  legally 
enforceable  for  dealing  with  the  disease.  The  Medical  Depart- 
ment have  had  to  rely  on  persuasive  measures;  but  much  has 
been  done,  especially  on  the  sugar  estates,  23  of  which,  or 
nearly  50  per  cent.,  have  been  induced  to  provide  proper  latrine 
accommodation  for  labourers.  In  the  ^'illage  and  country  districts, 
the  latrine  accommodation  is  very  unsatisfactory;  but  in  the 
opinion  of  the  Surgeon-General,  the  matter  is  not  so  important 
there  as  on  the  sugar  estates.  The  ^dllage  councils,  under  the 
guidance  of  the  Local  Government  Board,  are  making  every  effort 
to  improve  the  sanitary  condition  generally,  so  far  as  their  finances 


APPENDIX   A  261 

allow.  The  Surgeon-General  has  recommended  the  enactment  of 
legislation  to  compel  owners  to  provide  proper  accommodation  on 
estates ;  but  the  G-overnor  wishes  to  postpone  action,  in  view  of 
the  precarious  financial  condition  of  the  estates.  The  Secretary 
of  State  has  suggested  to  him  that  it  might  in  any  case  be  possible 
to  make  the  allotment  of  new  indentured  labourers  to  an  estate 
conditional  on  the  provision  of  satisfactory  sanitary  arrangements.^ 
The  treatment  of  individuals  with  thymol,  beta-naphthol,  or  euca- 
lyptus appears  to  be  well  understood,  medical  officers  using  one 
or  other  of  these  drugs  according  to  individual  preference. 

Jamaica. — Ankylostomiasis  is  prevalent  in  certain  districts, 
especially  among  the  Indian  labourers.  No  sanitary  measures 
have  been  enforced  on  estates.  A  circular  advocating  the  pro- 
vision of  latrine  accommodation  was  sent  to  estate  owners  some 
years  ago;  but  although  something  was  done  on  a  few  estates, 
there  was  a  difficulty  in  compelHng  the  coolies  to  use  the  latrines, 
and  no  serious  effort  was  made  by  employers  to  carry  out 
the  suggestion  of  the  Government.  Treatment  with  thymol 
appears  to  be  general  in  Jamaica.  The  Governor  proposes  to 
consider  amendments  of  the  law  to  give  the  Medical  and  Immigra- 
tion Departments  power  to  enforce  sanitary  regulations.  The 
general  opinion  of  the  medical  officers  is  that  the  treatment  of 
the  population  en  masse  is  impracticable,  and  stress  is  mainly  laid 
on  sanitary  measures.  Notification  of  cases  is  recommended. 
The  conditions  in  the  villages  seem  to  be  fairly  satisfactory. 

Leeward  Islands.  —  Ankylostomiasis  is  not  prevalent,  except, 
perhaps,  in  Antigua.  No  sanitary  measures  are  enforced.  No 
special  measures  are  considered  necessary,  beyond  the  erection  of 
additional  latrines  in  centres  of  population.  Individual  cases 
have  been  treated  with  thymol. 

Trinidad. — No  special  report  has  been  received.  The  Factory 
Ordinance,  now  under  consideration,  contains  a  clause  enforcing 

^  The  Governor  has  now  issued  a  circular  to  estate  owners,  warning 
them  that  the  allotment  of  immigrants  in  future  years  may  be  made  con- 
ditional on  the  provision  of  suitable  latrine  accommodation. 


262  APPENDIX    A 

the  provision  and  use  of  suitable  sanitary  accommodation,  wherever 
groups  of  ten  or  more  persons  are  employed  on  a  sugar  estate,  the 
accommodation  to  be  within  100  yards  of  the  place  where  the 
persons  are  employed,  and  imposes  a  penalty  on  the  misuse  of  such 
accommodation. 

Windward  Islands. — It  is  estimated  that  two-thirds  of  the 
labouring  population  in  St  Vincent  are  infected.  No  sanitary 
measures  are  in  force,  and  no  latrine  accommodation  exists  on 
estates,  while  that  in  the  villages  is  inadequate.  The  Adminis- 
trator of  St  Vincent  expresses  the  opinion  that  no  successful 
campaign  against  ankylostomiasis  is  possible  without  a  much 
more  numerous  and  efficient  medical  staff.  The  medical  officer  of 
Kingstown  suggests,  besides  the  usual  sanitary  measures,  the 
supply  of  drugs  and  microscopes  to  medical  officers.  In  St  Lucia 
the  disease  is  very  prevalent.  The  Administrator  thinks  that  the 
Board  of  Health  have  powers  to  enforce  sanitary  measures  at  all 
factories  and  estates :  but  for  this  purpose  funds  would  be 
required  for  inspection.  No  sanitary  measures  are,  in  fact,  in 
force,  and  no  latrine  accommodation  exists  on  estates.  The 
villages  are  better  provided  in  this  respect.  The  medical  officers 
regard  treatment  en  masse  as  impossible.  They  recommend  the 
instruction  of  the  school  children  in  simple  sanitary  rules.  The 
Administrator  suggested  that  some  part  of  the  cost  of  treatment 
of  labourers  should  be  thrown  on  employers,  but  the  Governor 
appeared  to  think  this  impracticable.  In  Grenada  ankylostomiasis 
has  not  reached  very  serious  proportions.  The  Governor 
doubts  the  efficacy  of  any  sanitary  measures,  since  the  labourers 
are  not  employed  in  large  numbers  on  estates,  and  are  constantly 
moving  from  place  to  place,  being  consequently  very  difficult  to 
control  in  sanitary  matters.  Something  might  be  done  by 
persistent  teaching  in  the  schools :  but  he  was  not  optimistic.  The 
Secretary  of  State  drew  the  Governor's  attention  to  the  allegation 
that  the  schools  were  not  provided  with  adequate  latrines,  and 
asked  that  the  matter  might  be  looked  into. 

Uth  October  1908. 

Note. — Since  the  above  memorandum  was  written,  a  dispatch 
has  been  received  from  the  officer  administering  the  government 


Appendix  a  26^ 

of  Trinidad,  from  which  it  appears  that  the  legislature  will  shortly 
be  invited  to  deal  with  the  question  of  sanitary  accommodation  on 
estates  and  in  the  largest  centres  of  population.  The  Surgeon- 
General  has  arranged  with  the  majority  of  estates  proprietors  to 
provide  at  their  hospitals  small  microscopes  and  other  apparatus. 


APPENDIX  B 

REPORTS  RELATING  TO  MOSQUITO-CARRIED 
DISEASES  IN  ST  LUCIA 

Being  the  Replies  to  the  CrRCULAR  Letter  of  the  Adminis- 

TEATOE  ASKING  FOE  A  EeTUEN  OF  MOSQUITO-BOENE   DISEASES 

IN    THE  Island,  also  on  the    Prevention    of  Teopical 
Anaemia. 

Dr  Hughes  to  the  Administrator. 

Denneey  Hospital, 

6eA  December  1905. 
SlE, 

In  reply  to  your  circular  letter  of  the  25th 
November  1905,  I  have  the  honour  to  forward  a  return  showing 
number  and  description  of  mosquito-borne  diseases  in  the  district 
during  the  last  twelve  months. 

The  number  coming  under  my  notice  as  a  private  practitioner 
extend  only  over  a  period  of  five  months,  as  I  took  charge  of  this 
district  on  4th  July  1905. — I  have,  etc., 

A.  F.  Hughes. 

Return  of  Mosquito-lorne  Diseases  for  the  Fourth  District  for  the 
past  Twelve  Months. 


Diseases. 

Number. 

Remarks. 

Malarial  Fever. 

Quotidian 

. 

... 

Intermittent. 

Tertian 

158 

The  majority  of  these  are  females 
below  25  years. 

Irregular 

2 

... 

Bilious. 

Remittent 

1 

Private  practice. 

Perniciovs. 

... 

... 

2.  Filaria. 

Elephantiasis 

1 

... 

Total 

162 

FIG.   45. — "WATEE-HOLDING   AND   MOSQUITO-BREEDmG  EPIPHYTES 
UPON   A   TREE,   TEINIDAD. 


[Face  page  264. 


APPENDIX  B 


265 


Z>r  King  to  the  Administrator. 


Castries, 
\%th  December  1905. 


Sir, 


In  reply  to  your  circular  of  25  th  November 
regarding  mosquito-borne  disease,  I  beg  to  submit  the  following 
figures : — 


Month. 

Cases 

December  1904 .            .           .           .        16 

January  1905     . 

19 

February  1905  . 

12 

March  1905 

18 

April  1905 

39 

May  1905 

51 

June  1905 

13 

July  1905 

18 

August  1905 

20 

September  1905 

18 

October  1905     . 

22 

November  1905 

40 

Total  . 

286 

2.  Of  other  preventable  diseases,  the  intestinal  parasites  are 
the  most  important.  In  my  opinion,  these  parasites  cause  far 
more  serious  illness  and  more  deaths  than  do  the  mosquito-borne 
diseases  in  this  colony.  To  them  is  largely  due  the  large  infantile 
mortality  here. 

In  the  towns  it  is  the  Ascaris  lumhricoides  which  is  most 
prevalent,  and  nothing  but  cleanly  habits  among  the  people  can 
prevent  persons  becoming  infected. 

In  the  country  there  are  places  which  are  infected  by  Anhylos- 
tomum  duodenale  to  such  an  extent,  that  even  were  rigorous 
measures  enforced,  these  places  would  continue  infective  for  a 
long  time.  It  is  noticeable  that  the  places  where  the  villages  are 
worst  kept  and  dirtiest,  and  where  the  people  are  filthiest  in  their 
habits  (Eoseau)  give  the  largest  number  of  cases. 


266  APPENDIX   B 

Another  preventable  disease  which  appears  to  be  on  the 
increase  is  enteric  fever,  but  cases  are  very  few  and  far  between, 
and  I  have  never  been  able  to  trace  the  origin  of  any  case. 

Infantile  diarrhoea  is  not  often  prevalent,  but  much  might  be 
done  to  prevent  it. 

I  have,  etc., 

Alex.  King. 


Copy  of  a  Circular  on  the  Prevention  of  Ankylostomum 
Anaemia. — St  Lucia. 

The  disease  which  usually  gives  the  people  "  palpitation "  or 
"beating  of  the  heart,"  "giddiness,"  "shortness  of  breath,"  and 
sometimes  "  sour  stomach,"  is  very  often  caused  by  a  kind  of 
worm,  and  can  be  prevented. 

The  worm  (which  is  very  small)  lives  in  a  person's  bowels,  and 
the  eggs  pass  when  the  bowels  move.  In  wet  earth  the  eggs 
are  hatched  to  very  small  worms — too  small  to  be  seen — 
which  enter  the  skin  of  the  feet  of  anyone  who  walks  on  the 
soiled  earth,  or  enter  by  the  mouth  of  a  person  who  eats  with 
fingers  which  have  touched  the  soiled  earth.  They  reach  the 
bowels,  suck  blood  from  them,  and  cause  sickness. 

If  a  person  who  has  the  sickness  eases  his  bowels  where  others 
may  walk,  he  may  spread  the  disease.  Many  people  who  do  not 
feel  very  sick  have  these  worms,  so  nobody  should  ease  his 
bowels  in  a  place  where  other  people  may  walk. 

To  prevent  this  disease : 

1.  Always  wear  boots  if  you  can. 

2.  Never  eat  without  first  washing  your  hands;  never  let 

your  children  eat  without  first  washing  their  hands. 

3.  Never  ease  your  bowels  where  any  person  may  walk; 

always  use  a  latrine  or  buckets  when  possible. 

4.  Be  careful  with  latrine  buckets.     Empty  them  at  the 

proper  place ;  never  spill  them  in  the  street. 

5.  Train  your  children  carefully  in  these  matters.     Never 


FIG.   46 THE  BA^rP.OO. 

The  cut  cane  freciuently  holds  water  in  which  Mosquitos  breed. 


[Face  page  266. 


APPENDIX   B  267 

let   them   ease   their   bowels  about  the  yards  of  the 
houses.     Children  often  have  the  disease. 

6.  All  excreta  should  be  buried  at  least  six  inches  below 
the  ground.     If  this  is  done  no  harm  can  follow. 

These  instructions  are  for  your  own  benefit,  to  prevent  you 
falling  sick  from  this  disease. 


APPENDIX  C 

CIRCULARS  ISSUED  BY  THE  HEALTH  AUTHORITIES 
OF  BARBADOS  UPON  THE  SUBJECT  OF  YELLOW 
FEVER  AND  MOSQUITO  DESTRUCTION 

Upon  the  necessity  of  Prompt  Screening  and 
Mosquito  Destruction, 

In  reference  to  my  circular  of  the  29th  December  last,  in  respect 
to  the  carrying  out  of  the  yellow  fever  regulations,  I  have  been 
directed  to  ask  that  your  board  will,  if  they  have  not  already 
done  so,  at  once  procure  and  have  ready  for  immediate  use, 
and  have  replenished  as  same  wears  out,  as  much  mosquito 
netting  as  will  effectively  screen  six  patients,  and  will  arrange 
that  on  a  case  of  yellow  fever  being  notified  to  your  inspector 
the  patient  shall  be  screened,  so  as  to  prevent  mosquitos  from 
spreading  the  infection;  and  will  also  at  the  same  time  take 
steps  under  Regulation  4  to  destroy  the  mosquitos,  as  well  in 
the  infected  house  as  in  any  neighbouring  houses  which  the 
doctor  may  think  necessary,  and  in  pools  round  about  the  houses ; 
and  will  keep  under  observation  for  eighteen  days  all  "  contacts  " 
of  the  patient,  and  from  the  twelfth  to  the  eighteenth  day  will 
have  such  contacts  examined  daily  by  a  medical  man. 

As  it  is  highly  desirable  in  the  interests  of  the  public  health 
that  any  case  of  the  disease  occurring  should  be  dealt  with  with 
as  little  delay  and  as  effectively  as  practicable,  I  am  directed  to 
express  the  hope  that  your  board  will  do  everything  possible  to 
deal  promptly  and  effectively  with  any  case  which  may  occur  in 
your  parish;  and  in  order  to  assist  you  in  doing  so,  my  board 
will  be  willing  to  receive  at  Pelican  Island  any  first  cases,  not 

268 


APPENDIX   C  269 

exceeding  four,  which  your  board  may  not  be  able  to  deal  with 
effectively  at  their  homes. 

Jas.  Sandeeson, 
Clerh^  General  Board  of  Health. 
^ihJa/nnuiry  1909. 

The  Chairman,  Commissioners  of  Health. 


Orders  made  under  section  8  of  the  Public  Health  Act 

of  1898. 

Importance  of  Suspicious  Cases  and  PPwEvention  of  Wakes. 

1.  Immediately  on  the  inspector  of  health  of  a  parish  being 
satisfied  of  the  existence  of  a  case  or  suspicious  case  of  yellow 
fever  in  the  parish,  he  shall  at  once  affix  to  a  conspicuous  part  of 
the  house  in  which  the  sick  person  is,  a  "poster"  with  these 
orders  printed  thereon. 

2.  After  such  poster  shall  have  been  so  afiSxed,  no  persons 
other  than  those  persons  actually  residing  in  the  house  or  in 
immediate  attendance  on  the  sick  person,  or  who  may  be 
authorised  by  the  medical  attendant,  shall  enter  such  house 
until  such  house  has  been  effectively  fumigated. 

3.  Where  any  death  occurs  from  yellow  fever,  no  assemblage 
of  persons  in  or  about  the  house  where  the  death  occurs,  and  no 
"  waking  of  the  dead  "  shall  take  place. 

4.  The  three  foregoing  orders  shall  for  the  present  be  limited 
and  apply  only  to  the  parish  of  St  Lucy. 

Made  by  the  General  Board  of  Health,  this  12th  day  of  January 
1909. 

W.  K.  Chandlee, 

President. 
14th  Jwmiary  1909. 

As  I  have  elsewhere  stated,  in  the  absence  of  a  principal 
medical  officer  of  health,  and  yellow  fever  still  continuing  to 
be  notified  in  the  parishes,  the  board  of  health  requested  one  of 


270  APPENDIX   C 

their  number  to  make  a  survey  and  to  report  upon  the  situation. 
Dr  Hutson,  the  gentleman  deputed,  reported  as  follows  :  ^ — 

Harmony  Hall, 
2th  Januart)  1909. 

Sib, 

At  the  request  of  your  board,  conveyed  in  your 
letter  of  the  5th  inst.,  I  visited  the  parish  of  St  Lucy  on 
Thursday,  the  7th  inst.,  in  order  to  enquire  into  the  situation 
with  regard  to  the  outbreak  of  yellow  fever  reported  from  that 
parish. 

(c)  With  regard  to  suggestions  for  dealing  with  the 
existing  situation,  I  found  that  all  the  most  important 
necessary  measures  had  already  been  decided  on, 
although  nothing  had  actually  been  done,  owing  to 
the  uncertainty  of  obtaining  the  necessary  funds. 

The  chairman  of  the  sanitary  commissioners  handed 
me  the  following  list  of  measures  decided  on  by  the 
sanitary  board  at  a  special  meeting  on  29th  December, 
which  had  been  communicated  by  him  to  the  President 
of  the  Board  of  Health.  I  quote  his  written 
memorandum : — 

1.  Isolation  hospital. 

2.  A  daily  house-to-house  inspection,  with  a  view  to  report 

instantly  to  the  parochial  medical  ofi&cer  all  cases  of 
sickness.     Six  or  eight  inspectors  may  be  necessary. 

3.  The  parochial   medical  officer    to    attend    such    cases 

without  any  delay,  with  the  view  of  removing  the 
patient  to  the  isolation  hospital,  if  practicable,  and  also 
contacts. 

4.  All  houses   that  contain  yellow   fever  patients  to   be 

placarded,  forbidding  all  people  entering, 

5.  All  expenses  incurred  to  be  borne  by  the  Government. 

In  your  letter  to  the  Chairman  of  the  Sanitary  Commissioners, 
forwarded  to  him  by  me  on  Thursday,  all  these  measures  were 

^  I  have  omitted  details  of  visits,  etc. 


APPENDIX  C  271 

insisted  on  except  the  placarding  of  houses,  which  in  my  opinion 
would  be  a  useful  measure.  The  chairman  points  out,  however, 
that  this  would  be  useless  unless  enforced  by  some  policemen  in 
uniform,  as  the  ordinary  rural  constable  has  not  sufficient 
authority  to  enforce  measures  of  this  kind.  It  appears  that  the 
fatal  results  of  so  many  cases  have  caused  an  immense  sensation 
in  the  district,  and  people  and  friends  in  the  neighbourhood  crowd 
into  infected  houses  to  visit  the  sick  and  in  some  cases  spend  the 
night  there.  The  medical  officer  informed  me  that  he  counted 
eleven  persons  come  out  of  a  room  where  a  yellow  fever  patient 
was  lying  ill ,  although  he  had  given  instructions  that  no  one  was 
to  visit  the  house.  When  I  visited  the  man  Johnson,  who  was 
dying  of  yellow  fever,  there  were  quite  a  dozen  persons  in  the 
room  and  at  the  door  of  the  house.  Of  the  fatal  cases,  EoUock 
was  a  visitor  at  Bowen's  house  and  Johnson  at  EoUock's  house. 

6.  The  question  of  contacts  has  been  dealt  with  by  the  Board 
of  Health  and  a  daily  inspection  by  sub-inspectors  has  been 
ordered,  followed  by  a  medical  inspection  from  the  twelfth 
to  the  eighteenth  day  after  the  isolation  of  the  case  with  which 
they  have  been  in  contact. 

The  Chairman  of  the  Sanitary  Commissioners  and  the  medical 
officer  are  of  opinion  that  this  medical  inspection  is  impracticable 
unless  these  persons  are  forced  to  remain  at  home  or  are  made  to 
go  to  some  central  place  and  be  kept  there. 

This  is  a  serious  difficulty  that  must  be  considered  by  the 
Board  of  Health, 

I  think  the  number  of  contacts  will  be  much  reduced  by 
preventing  visitors  to  an  infected  house,  and  the  actual  inhabi- 
tants of  the  house  will  generally  be  available  for  inspection  when 
the  medical  officer  visits, 

I  suggest  that  the  Board  of  Health  pass  an  order,  under  section 
8  of  the  Public  Health  Act,  1898,  that  infected  houses  should  be 
placarded  and  visitors  not  allowed. 

7.  Another  important  matter  is  the  prevention  of  "  wakes,"  as 
provided  for  in  No,  23  of  the  cholera  rules  made  in  1893,  in  the 
case  of  that  disease.  This  provision  should  be  extended  to  all  the 
quarantinable  diseases.  I  am  led  to  suggest  this  because  I  was 
informed  that  in  one  of  these  cases  at  least  a  wake  was  actually 


272  APPENDIX  C 

held,  A  collection  of  persons  at  night  in  a  house  where  infected 
mosquitos  are  likely  to  be  is  specially  dangerous  in  the  presence 
of  yellow  fever.  This  provision  would  only  be  necessary  if  the 
previous  suggestion  I  have  made  is  not  carried  out.  If  visitors 
are  excluded,  wakes  will  not  take  place,  except  they  are  carried  on 
by  the  family  in  the  house — an  unlikely  event  in  any  case. 

8.  It  will  be  necessary  to  provide  one  or  more  houses  in  the 
district,  to  which  persons  can  be  moved  after  isolation  of  a  patient 
while  disinfection  is  being  carried  out.  This  is  necessary  if 
disinfection  is  done  after  dark,  as  it  should  be,  in  order  to  destroy 
as  many  mosquitos  as  possible,  and  especially  the  mosquitos  that 
are  active  after  sunset. 

9.  The  most  important  measure,  and  one  which  should  be 
most  thoroughly  and  carefully  done,  is  the  destruction  of 
mosquitos  by  treating  with  kerosene  oil,  Jeyes'  fluid,  or  white  lime 
all  water-holes  and  collections  of  water  in  hollows  or  in  privy-pits. 
In  short,  the  breeding  places  of  mosquitos  must  be  attacked  and 
abolished  by  drainage  as  far  as  possible,  and  where  this  is  not 
possible  the  water  must  be  treated  in  order  to  destroy  mosquito 
larvae.  One  man  at  least  should  devote  his  whole  time  to  this 
small  district,  and  his  work  should  be  carefully  supervised  by  the 
medical  officer  and  the  sanitary  inspector  when  they  are  visiting  the 
district  daily. 

The  destruction  of  mosquitos  has  already  been  suggested 
in  the  letter  of  your  Board  to  the  chairman,  and  I  specially 
impressed  on  him  the  necessity  for  this  measure,  and  urged  that 
it  should  be  commenced  on  Thursday  at  once. 

10.  It  will  be  necessary  to  deal  with  all  suspicious  cases  as  if 
they  were  yellow  fever,  and  not  wait  for  positive  symptoms  to 
develop  before  screening  and  isolation  are  carried  out ;  mosquito 
netting  has  already  been  provided.  An  attempt  had  been  made  to 
screen  one  of  the  patients  I  visited.  The  attempt  did  not  reflect 
much  credit  on  the  inspector  who  had  carried  it  out. 

The  control  of  the  disease  by  preventing  access  of  mosquitos 
to  patients,  is  almost  impossible  in  an  isolated  country  district 
where  the  people  are  accustomed  to  wait  some  days  after  an  illness 
commences   before   calling  the  doctor;    but  the  daily  house-to- 


APPENDIX  C  273 

house  inspection  will  do  much  to  discover  new  cases  in  the  early- 
stage.  More  reliance  must  be  placed  on  the  general  destruction 
of  mosquitos  by  destroying  their  breeding  places,  and  on  the 
special  destruction  of  infected  mosquitos  by  fumigation. 

To  recapitulate, — 

The  necessary  measures  are,  as  already  described, — 

1.  The  general  destruction  of  mosquitos  and  the  special 

destruction  of  mosquitos  in  infected  houses. 

2.  The  provision  of  an  isolation  hospital  for  the  treatment 

of  all  suspected  cases. 

3.  A  daily  house-to-house  visitation  in  the  infected  district, 

with  inspection  of  contacts,  and  medical  inspection  of 
contacts  after  the  twelfth  day. 

4.  Immediate  report  to  the  medical  officer  of  all  cases  of 

illness  in  the  district. 

5.  The  appointment  of  inspectors  for  the  daily  inspection 

and  patrol  of  the  district. 

All  these  have  already  been  done  or  are  arranged  for  as  soon 
as  it  is  possible  to  start  them. 

The  following  additional  measures  are  recommended : — 

6.  The  control   of  contacts  by  placarding  of   houses  and 

restriction  of  visitors.  For  this  purpose  a  special 
order  would  have  to  be  made  by  the  Board  of  Health 
under  section  8  of  the  Public  Health  Act. 

7.  The  prevention  of  wakes  by  order. 

8.  The  provision  of  temporary  accommodation  for  contacts 

while  infected  houses  are  being  fumigated. 

9.  The  effective  control  of  all  suspicious  cases  before  the 

complete  development  of  the  disease. 

The  condition  of  the  standpipes  in  Pie  Corner  and  the  need 
of  a  special  squad  of  police  have  been  referred  to  in  previous 
pages.  I  further  recommend  that  a  permanent  infectious  diseases 
hospital  be  arranged  for  in  St  Lucy,  seeing  that  since  1902  this  is 


274  APPENDIX  C 

the  third  time  that  provision  has  been  made  for  meeting  an 
epidemic,  and  each  time  the  special  equipment  is  disposed  of. 

With  regard  to  what  has  actually  been  done,  the  Chairman  of 
the  Board  arranged  to  summon  a  meeting  of  the  Sanitary 
Commissioners  for  Saturday  (yesterday),  at  which  Durham  School- 
house  would  be  appointed  for  the  use  of  the  almshouse  inmates,  so 
that  the  almshouse  may  be  used  as  an  isolation  hospital.  Sub- 
inspectors  were  appointed  by  the  chairman  immediately  after  my 
visit,  as  he  had  names  ready  for  appointment. 

Special  attention  was  to  be  directed  to  the  destruction  of 
mosquitos  in  water-holes,  and  a  supply  of  mosquito  netting  for 
the  hospital  was  arranged  for  through  yourself  as  Clerk  of  the 
Board  of  Health  after  my  return  from  St  Lucy,  as  well  as 
additional  supplies  of  sulphur  and  Jeyes'  fluid.  At  Dr  Massiah's 
suggestion  I  have  engaged  two  nurses  in  readiness  to  go  down 
when  he  notifies  he  is  ready  for  them. 

The  great  length  of  this  report  prevents  reference  to  many 
points  of  interest  connected  with  the  origin  of  the  outbreak  and 
the  methods  of  notification,  as  well  as  the  difficulties  met  with 
in  getting  hold  of  the  early  cases  of  the  disease ;  but  I  have  tried 
to  confine  myself  to  the  actual  points  referred  to  in  your  letter 
of  the  6th  inst. 


Circular  upon  importance  of  immediate  Isolation, 
Screening,  and  careful  Fumigation. 

1.  In  reference  to  my  circular  of  the  4th  January  last,  I  have 

been  directed  to  say  that  the  screening  of  any  person  suffering 
from  yellow  fever,  or  a  fever  suspected  to  be  yellow  fever,  may  be 
done  either  by  a  netting  put  over  the  patient's  bed  or  by  mosquito 
(netting)  frames  made  to  fit  over  the  doors  and  windows  of  the 
room  in  which  the  patient  is,  so  as  to  prevent  mosquitos  getting 
into  it. 

2.  I  have  been  further  directed  to  say,  that  the  question  having 
been  raised  at  a  meeting  of  the  Board  yesterday,  as  to  whether  it 
was  necessary  that  the  fumigation  of  infected  houses  should  be  done 
under  the  supervision  of  a  medical  man,  the  Board  were  of  opinion 


APPENDIX  C  275 

that  if,  or  when  the  Commissioners  of  Health  for  a  parish  are 
satisfied  that  their  inspector  is  competent  to  carry  out  such 
fumigation,  such  fumigation  need  not  be  supervised  by  a 
medical  man. 

3.  The  question  as  to  whether  a  person  who  is  suffering  from 
yellow  fever,  or  a  fever  suspected  to  be  yellow  fever,  and  cannot 
be  effectively  isolated  on  their  own  premises,  but  refuses  to  be 
removed  to  an  isolation  hospital,  can  be  forcibly  removed  to  such 
hospital,  was  brought  before  the  Board  of  Health  yesterday,  and  I 
was  directed  to  say,  for  your  information,  that  if  such  a  person  has 
been  duly  certified  by  a  medical  man  to  be  suffering  from  yellow 
fever,  or  a  fever  suspected  to  be  yellow  fever,  the  police  would  be 
authorised,  without  any  further  warrant  than  the  doctor's  certifi- 
cate, to  enter  the  house  of  such  person,  after  demanding  admittance 
thereto,  even  by  breaking  into  it,  and  remove  the  person  to  the 
isolation  hospital ;  but  if  such  medical  certificate  has  not  or  cannot 
be  obtained,  then  the  sick  person  cannot  be  removed. 

4.  Should  it  happen  that  any  ill  person  in  your  parish  should 
refuse  to  be  seen  by  a  medical  man,  so  as  to  enable  him  to  give  the 
necessary  certificate,  and  such  person  cannot  be  induced  to  see  the 
medical  man,  then  the  fact  should  be  notified  to  me,  so  that  the 
Board  may  deal  with  the  matter. 

5.  The  Board  of  Health  yesterday  made  a  general  order  for- 
bidding the  assemblage  of  persons  and  the  holding  of  "  wakes  "  in 
any  house  where  a  death  has  occurred  from  yellow  fever.  A  copy 
of  the  order  is  sent  herewith. 

Jas.  Sandekson, 
Clerh^  General  Board  of  Health. 
Uh  Fehrvmy  1909. 

Sent  to  Commissioners  and  Inspectors  of  Health  and  Parochial 
Medical  Ofl&cers. 


276  APPENDIX  C 

Order  made  under  section  8  of  the  Public  Health  Act, 
forbidding  Wakes. 

1.  Where  any  death  occurs  from  yellow  fever,  no  assemblage 
of  persons  in  or  about  the  house  where  the  death  occurs,  and  no 
"  waking  of  the  dead,"  shall  take  place. 
Made  by  the  General  Board  of  Health,  this  3rd  day  of  February 

1909. 

W.  K.  Chandler, 

President. 
I  approve.— G.  T.  Caeter, 

Governor. 

Ath  February  1909. 

Circular  drawing  attention  to  Tardy  Notification. 

Complaints  having  been  made  by  some  of  the  colonies  who  are 
parties  to  the  Quarantine  Convention,  and  also  by  the  Foreign 
Consuls  here,  as  to  the  length  of  time  which  in  many  of  the 
reported  yellow  fever  cases  had  elapsed  between  the  case  being 
diagnosed  and  the  receipt  of  the  report  of  it  by  the  Board  of 
Health,  I  have  been  directed  to  ask,  that  should  you  have  a  case  of 
that  disease  you  will  at  once  send  me  direct  a  notice  thereof  on 
the  top  memorandum  of  the  notification  form,  in  addition  to  the 
usual  notification  to  the  Inspector  of  Health. 

Jas.  Sanderson, 
Clerk^  General  Board  of  Health. 
8th  Fehricary  1909. 

Sent  to  all  Medical  Practitioners. 


Circular  upon  the  necessity  of  Increased  Vigilatice,  and 
the  appointment  of  a  Central  Inspector  and  better 
Sanitary  Supervision  of  Parishes. 

At  a  meeting  of  the  Board  of  Health  yesterday,  it  was  decided 
to  appoint  a  Central  Inspector  to  inspect  day  by  day  Bridgetown 


APPENDIX  C  277 

and  its  suburbs  and  the  towns  and  villages  and  rural  portions  of 
the  several  parishes,  for  the  purpose  of  ascertaining  that  the  sani- 
tation thereof  was  being  efficiently  and  continuously  carried  out, 
and  also  to  bring  to  the  notice  of  the  proper  parochial  authority, 
any  matter  which  in  the  opinion  of  the  inspector  required  looking 
after,  and  to  report  from  time  to  time  on  his  work  to  the  Board. 
Mr  Cumberbatch  was  appointed. 

The  Board  also  decided  to  request  the  Commissioners  of  Health 
of  each  parish,  if  they  had  not  yet  done  so,  to  divide  up  their 
parish  into  workable  districts,  and  to  place  in  charge  of  each 
district  one  or  more  (according  to  the  size  of  the  district)  sanitary 
inspectors,  with  instructions  to  visit  daily  the  houses  in  the 
district  and  report  to  the  Parochial  Medical  Officer  of  the  parish 
all  persons  found  to  be  ill  with  fever.  Each  inspector  to  report 
daily  to  the  Chairman  of  the  Commissioners  the  sanitary  and 
health  conditions  of  his  district,  so  as  to  ensure  prompt  medical 
attendance  on  every  fever  patient  and  the  efficient  sanitation  of 
the  whole  parish. 

The  Board  trust  that  your  Commissioners  will  comply  with 
their  request  in  this  matter  with  as  little  delay  as  practicable. 

The  Board  are  recommending  the  Central  Government  to  bear 
the  cost  of  the  measures  above  referred  to,  and  have  no  doubt 
that  this  recommendation  will  be  favourably  received. 

Jas.  Sandeeson, 

Clerh,  General  Board  of  Health. 
8th  February  1909. 

Sent  to  Commissioners  of  Health  of  all  Parishes. 


Diary  of  the  Central  Inspector,  ^th  to  21st  February. 

I  have  examined  the  diary  of  Central  Inspector  Cumberbatch ; 
it  shows  that  this  inspector  was  fully  alive  to  the  importance  of 
the  duties  entrusted  to  him.  The  diary  commenced  on  8th 
February.  I  notice  that  on  9th  February  he  draws  attention  to 
the  small  accumulations  of  water  which  occur  round  standpipes. 
On  the  10  th  he  states : — "  Caused  several  barrels  containing  water 
filled  with  larvse  and  mosquitos  to  be  emptied,  and  explained  to 


278  APPENDIX  C 

the  occupants  my  reasons  for  so  doing."  He  also  draws  attention 
to  the  following,  in  connection  with  fumigation  of  a  case  of  yellow 
fever : — "  I  do  not  think  that  as  much  care  in  stopping  all  crevices 
was  taken  as  might  have  been."  He  adds :  "  I  explained  to  the 
people  of  this  neighbourhood  the  '  Mosquito  Theory/  and  warned 
them  about  the  water  in  barrels  and  casks,  and  explained 
'  Fumigation.' " 

12th  FebrvMry.  —  With  regard  to  the  fumigation  of  another 
house,  he  states : — "  This  house  was  improperly  fumigated,  as  it 
was  not  made  tight  enough  before  the  fumigation  was  started." 
Again,  four  houses  and  a  meeting-room  next  to  this  house  were  not 
fumigated, 

l^th  February. — I  caused  a  good  amount  of  water  with  larvae 
and  mosquitos  to  be  thrown  away  in  this  district,  and  explained 
to  the  people  why  I  acted  thus. 

VJth  Felruary. — I  found  many  vessels  containing  water  with 
larvae  and  mosquitos;  had  them  emptied,  and  explained  to  the 
people  my  reason  for  so  doing. 

18^^  February. — I  threw  away  several  vessels  of  water  contain- 
ing larvae  and  mosquitos. 


Rules  for  dealing  with  cases  of  Yellow  Fever, 

For  the  general  guidance  of  medical  men  and  sanitary 
inspectors,  the  following  rules  for  dealing  with  cases  of  yellow 
fever  occurring  in  Barbados  were  issued  by  the  Board  of  Health 
on  21st  January  1909  : — 

1.  Any  person  certified  by  a  medical  practitioner  to  be  suffering 
from  yellow  fever,  or  a  fever  suspected  to  be  yellow  fever,  shall  as 
soon  as  possible  be  protected  effectively  at  his  own  expense  from 
access  of  mosquitos  on  the  premises  on  which  he  then  be,  and  be 
detained  there  until  his  medical  attendant  certifies  him  to  be  no 
longer  capable  of  imparting  infection  to  mosquitos ;  or  if  he 
cannot,  in  the  opinion  of   his  medical  attendant,  be   effectively 


APPENDIX  C  279 

isolated  from  mosquitoa  on  such  premises,  shall  be  taken,  with 
not  more  than  two  attendants,  if  such  attendants  desire  to  he 
taken,  to  some  place  previously  appointed  by  the  Board  of  Health 
for  the  reception  of  such  cases,  and  there  detained  until  he  is  no 
longer  capable  of  imparting  infection  to  mosquitos.  Provided 
that  no  patient  shall  be  removed  unless  a  medical  practitioner 
shall  certify  that  he  can  be  removed  without  endangering  his  life. 

2.  The  G-eneral  Board  of  Health  or  the  Commissioners  of 
Health  of  each  parish  may  in  their  discretion  send  a  qualified 
practitioner  to  examine  the  premises  in  which  a  person  certified  to 
be  suffering  from  yellow  fever,  or  a  fever  suspected  to  be  yellow 
fever,  is,  and  to  report  to  them  respectively,  whether  such  person 
can  be  effectively  protected  from  mosquitos  on  such  premises; 
and  the  said  Board  of  Health  or  the  said  Commissioner  may,  if 
they  are  satisfied  that  such  person  cannot  be  protected  as  afore- 
said, direct  his  removal  to  the  place  previously  appointed  as 
aforesaid. 

3.  If  any  patient  is  confined  to  his  own  premises  under  the 
restrictions  authorised  in  Eule  1,  on  his  becoming  free  from 
infection,  a  certificate  from  his  medical  attendant  to  this  effect 
shall  be  sent  by  him  to  the  sanitary  inspector  of  the  district. 

4.  As  soon  as  possible  after  a  case  of  yellow  fever  is  notified 
under  section  23  of  the  Public  Health  Act,  the  necessary  steps 
shall  be  taken  by  the  Commissioners  of  Health  of  the  parish  in 
which  the  patient  is  lying  ill,  to  thoroughly  destroy  by  fumigation 
with  sulphur  or  pyrethrum,  by  petrolisation,  or  otherwise,  the 
mosquitos  within  or  around  the  house  and  premises  in  which  the 
patient  is,  and  if  necessary  the  mosquitos  in  houses  or  premises 
adjacent  to  the  house  where  the  patient  is.  In  the  latter  case  a 
certificate  in  writing  shall  be  issued  by  a  qualified  medical 
practitioner  appointed  by  the  Commissioners  of  Health  for  this 
purpose,  or,  in  the  absence  of  such  officer,  by  the  medical  attendant 
of  the  patient,  stating  in  detail  the  houses  and  premises  which  in 
the  opinion  of  the  person  signing  such  certificate  should  be  dealt 
with  for  the  destruction  of  mosquitos. 

5.  The   procedure    for    the    protection   of   the   patient  from 


280  APPENDIX  C 

mosquitos  and  for  the  destruction  of  mosquitos  in  infected  houses 
and  premises  shall,  as  far  as  practicable,  conform  to  the  procedure 
described  hereunder,  viz. : — 

The  room  occupied  by  the  patient  shall  at  once  be  closed  by 
wire  gauze.  False  windows  and  doors  covered  with  wire  gauze 
shall  be  at  once  adjusted  to  the  openings  in  the  room.  The  doors 
and  other  openings  that  may  communicate  with  other  apartments 
in  the  house  shall  be  temporarily  closed  with  stout  paper  in  order 
to  prevent  the  entrance  of  smoke  into  the  room  occupied  by  the 
patient.  The  rest  of  the  house  shall  be  fumigated  if  necessary. 
To  do  this,  all  compartments  shall  be  carefully  closed.  Strips  of 
paper  shall  be  pasted  over  all  cracks.  Open  spaces  in  houses  shall 
be  closed  with  screens  of  stout  paper. 

After  the  fumigation  of  the  rest  of  the  house,  the  patient  shall 
be  transferred  to  one  of  the  fumigated  rooms,  previously  closed 
with  wire  gauze,  and  the  sick  chamber  shall  then  be  disinfected 
in  the  manner  hereinbefore  prescribed.  Neighbouring  houses 
certified  under  Eule  4  shall  be  treated  in  the  same  way. 

Petroleum  shall  be  poured  into  all  receptacles  where  mosquito 
larvae  may  grow. 

Fumigation  by  sulphur  is  recommended,  and  should  be  used  in 
the  proportion  of  3  lbs.  for  every  1000  cubic  feet  of  air- 
space. 

The  routine  of  disinfection  as  used  in  Havana  is  as  follows, 
namely : — The  inspector  assigns  one  man  to  each  of  the  windows  or 
openings  in  the  room.  The  duty  of  each  man  is  to  close  the 
openings  perfectly  by  pasting  strips  of  paper  over  all  cracks  and 
joints.  While  this  is  being  done,  the  inspector  has  measured  the 
cubic  space  of  the  room.  If  possible,  an  opening  is  left  somewhere 
for  the  admission  of  light ;  it  may  be  a  glass  pane  or  an  opening 
covered  with  paper.  On  the  window-sill  or  floor  below  this 
opening  a  sheet  of  moistened  white  paper  is  placed.  It  has  been 
found  that  the  mosquitos,  during  the  fumigation,  flock  toward 
this  opening,  and  when  paralysed  by  the  smoke  they  are  apt  to 
fall  upon  the  paper  below,  where  they  can  be  more  easily  gathered 
afterwards.  The  sulphur  or  pyrethrum  powder  is  now  placed  in 
pans  and  ignited  by  setting  fire  to  a  small  amount  of  alcohol  in 
each  pan.  One  door  has  been  left  open  for  exit  of  the  men. 
Before  leaving,  all  clothing  is  shaken  and  scattered  ahout  the  room. 


APPENDIX  C  281 

The  exit  door  is  now  closed  from  the  outside ;  its  joints  and  cracks 
are  pasted  over. 

Pyrethrum  is  burned  in  the  proportion  of  1  lb.  to  every 
1000  cubic  feet  of  space. 

At  the  expiration  of  four  hours  the  door  is  partially  opened  to 
allow  the  men  to  enter.  The  walls,  ceiling,  and  floor  are  carefully 
swept,  and  the  clothing  is  once  more  shaken.  Any  mosquitos 
found  to  be  still  living  are  thrown  into  the  pans. 

Before  leaving  the  house,  a  certificate  should  be  obtained  from 
the  family  to  the  effect  that  no  damage  has  been  done  to  the 
property  in  the  process  of  disinfection,  or  if  otherwise,  a  note  is 
taken  of  complaints  that  may  be  made. 


Hints  upon  Treatment  of  Yelloiv  Femr,  based  upon  those 
practised  by  Dr  Guiteras  of  Havana. 

The  statistics  of  the  mortality  in  our  hospital  show  the 
importance  of  early  treatment  in  yellow  fever :  not  that  we  have 
any  specific  that  must  be  applied  at  the  beginning  of  the  attack, 
but  that  rest  in  bed  constitutes  an  important  factor  in  the 
treatment. 

Excepting  the  administration  of  a  laxative  and  the  employ- 
ment of  some  palliative  measure,  nothing  else  has  been  done  here 
in  the  first  48  hours,  or  even  through  the  whole  attack  in  mild 
cases  where  there  was  no  special  indication. 

Our  treatment  here  is  published  in  detail  in  an  article  by 
Major  Gorgas,  U.S.A.,  in  the  Journal  of  the  Association  of 
Military  Surgeons  for  Octoier  1903. 

We  put  the  patient  to  bed  at  once  and  make  him  keep  the 
horizontal  position.  Clean  linen  for  the  bed  and  person  should 
be  furnished  plentifully.  Windows  and  doors  are  kept  open 
(mosquito-screened),  only  avoiding  direct  draughts.  Quarters 
should  be  very  clean.  Patients  seem  to  do  best  when  treated  in 
tents  or  newly  constructed  frame  buildings. 

The  skin  is  cleansed  and  rubbed  with  hot  water  and  soap  on 
admission.     It  is  not  unreasonable  to  suppose  that  these  measures 


282  APPENDIX  C 

may  lessen  the  chances  of  secondary  infections,  which  may  be  the 
cause  of  the  hsemorrhagic  manifestations. 

Water  is  given  freely  through  a  drinking-tube.  From  50  to 
SO  ounces  of  fluid  are  given  in  the  24  hours.  Pleasant  alkaline 
waters  and  infusions  and  ginger  ale  are  given.  The  patient  is  not 
allowed  to  sit  up  to  empty  bladder  or  rectum. 

Something  is  done  at  the  same  time  to  relieve  suffering  and  gain 
the  confidence  of  the  patient.  External  applications :  sinapisms, 
ice,  liniments.  If  the  temperature  be  very  high  the  surface  is 
sponged  with  cool  water  and  alcohol,  or  an  enema  of  cold  water 
is  given. 

Phenacetin  may  be  given  to  relieve  pain  at  night,  if  necessary 
once  or  twice,  but  should  not  be  insisted  upon. 

The  first  symptom  that  is  likely  to  call  for  special  treatment 
is  vomiting.  If  the  bowels  have  not  acted  since  the  initial  purge, 
Seidlitz  powder  in  broken  doses  to  mix  in  the  stomach,  or  minute 
doses  of  calomel  or  effervescent  magnesia,  is  given.  If  the  vomit- 
ing is  persistent,  the  administration  of  liquids  by  the  mouth  is 
discontinued,  and  only  cracked  ice  is  given,  and  rectal  injections 
of  warm  physiologic  salt  solution.  If  the  rectum  has  not  been 
irritated  by  frequent  purgation  this  can  be  kept  up  with  advan- 
tage.    Milk  may  be  added  later. 

Cocaine  tablets  and  ice  applied  to  the  throat  are  used  with 
advantage  in  vomiting. 

When  black  specks  appear  in  the  vomit,  tincture  of  the 
chloride  of  iron,  5  gtt.  every  2  or  3  hours,  is  usually  given,  with 
a  little  glycerine  and  lemon  juice.  For  haemorrhage  from  the 
mouth  an  antipyrine  wash  is  used. 

The  remainder  of  the  treatment  reduces  itself  to  sustaining 
the  strength  of  the  patient  and  stimulating  the  action  of  the 
heart  and  kidneys  by  the  judicious  use  of  strychnia,  digitalis,  and 
alcohol:  the  two  former  by  the  hypodermic  method  and  the 
latter  by  the  mouth  or  rectum.  Alcohol  is  not  well  borne  in 
large  doses.  The  same  may  be  said  of  strychnia.  Champagne  is 
the  best  form  of  alcohol. 

Cold-water  rectal  injections  and  calomel  as  a  diuretic  are  tried 
in  suppression  of  urine. 

The  prolonged  typhoid  cases,  often  marked  by  pronounced 
jaundice,  require  alcohol  and  strychnia.     Chlorate  of  potash  is 


APPENDIX  C  283 

given  with  apparent  advantage.  In  convalesence,  muriatic  acid 
and  nux  vomica. 

Feeding  with  milk  and  lime-water  is  commenced  on  the  third, 
fourth,  or  fifth  day.     The  quantity  of  milk  is  gradually  increased. 

About  the  ninth  day  a  mild  solid  diet  may  be  ordered. 

Very  mild  cases  have  recovered  completely  in  ten  days. 
Others  will  require  the  use  of  peptonised  food,  tonics,  and 
massage. 


APPENDIX  D 

COMPLAINT  OF  TARDY  NOTIFICATION  OF 
YELLOW  FEVER 

That  other  colonies  in  the  West  Indies  did  not  think  the 
medical  organisation  of  Barbados  was  equal  to  grapple  with  the 
epidemic  of  yellow  fever  of  1908-9,  we  have  had  evidence 
already. 

These  criticisms  all  point  in  the  one  direction  to  the  disadvan- 
tage of  Barbados  of  not  possessing  a  medical  head  in  the  colony. 

The  following  is  additional  testimony  in  this  direction,  and 
was  a  minute  sent  by  Sir  Frederic  Hodgson  to  the  Surgeon- 
General  of  British  Guiana  upon  the  report  of  Dr  Hutson  on  the 
sanitary  organisation  of  the  parish  of  St  Lucy,  Barbados : — 

It  is  clear  that  some  of  the  parochial  medical  officers  for 
Barbados  are  not  co-operating  with  the  Board  of  Health,  and  in 
fact  are  neglecting,  either  through  ignorance  of  the  aspects  of 
yellow  fever  cases  or  otherwise,  to  ejffect  prompt  isolation  and  to 
take  other  steps  required  by  the  Board.  It  was  so  in  the  case  of 
the  smallpox  epidemic  of  1903. 

2.  I  am  afraid  that  yellow  fever  will  become  more  rampant  in 
Barbados  than  it  is,  and  in  the  Demerara  Daily  Argosy  of  the 
4th  inst.  there  was  an  account  of  Dr  Hutson's  action  and  a 
statement  to  the  effect  that  40  cases  had  occmTcd  in  the  island. 

3.  The  Health  Officer  will  have  to  be  very  watchful.  Let  the 
Surgeon-General  see  this  minute. 

Frederic  H.  Hodgson. 
2/2/1907. 

284 


APPENDIX  E 
ANTIPLAGUE  MEASURES  IN  JAMAICA 

The  following  manifesto  has  been  issued,  July  1909,  to  the 
citizens  of  Kingston,  Jamaica  : — 

By  recent  telegrams  from  Trinidad  we  are  informed  that  there 
have  been  cases  of  bubonic  plague  in  that  island,  most  of  which 
have  terminated  fatally.  That  this  awful  disease  should  have 
reached  Trinidad  was  dreaded  by  all  in  authority,  and  especially 
those  cognisant  of  the  intimate  relationship  that  exists  between 
Venezuela  and  Trinidad. 

Trinidad  is  brought  into  closer  proximity  to  Jamaica  by  the 
fast  steamers  of  the  Eoyal  Mail  Company  and  other  lines  to 
Central  America,  and  this  makes  it  absolutely  necessary  for  the 
people  of  Jamaica  to  take  every  precaution  in  their  power  to 
prevent  the  introduction  of  such  an  awful  scourge  to  our  island. 

This  fell  disease  is  most  insidious,  taking  in  some  instances 
weeks  before  it  gets  fully  developed,  and  cases  are  on  record  where 
two  months  and  more  have  elapsed  between  the  introduction  of 
the  infection  and  the  outbreak  of  the  epidemic.  This  disease  is 
also  more  fatal  than  any  known  disease,  including  smallpox,  yellow 
fever,  and  cholera,  and  also  more  difficult  to  eradicate.  Therefore 
it  is  absolutely  necessary  that  every  citizen  should  do  his  best  to 
protect  not  only  his  own  life  and  the  lives  of  those  near  and  dear 
to  him,  but  also  the  welfare  of  the  entire  community. 

Plague  is  introduced  and  propagated  by  many  of  the  lower 
animals,  rats  being  the  worst  offenders  in  this  respect.  Mice, 
squirrels,  and  monkeys  also  carry  the   infection  but  in  a  lesser 


286  APPENDIX  E 

degree.  In  fact,  there  is  almost  invariably  an  outbreak  of  plague 
amongst  rats  previous  to  an  epidemic  of  this  disease  in  man. 

Plague  is  transmitted  from  the  rats  to  man  by  the  agency  of  fleas. 
It  is  therefore  quite  evident  that  personal  cleanliness,  and  good  and 
sanitary  environment,  are  important  adjuncts  to  the  prevention  of 
an  outbreak  of  this  disease.  Writers  on  this  subject  in  India  have 
shown  that  persons  who  habitually  walk  barefooted  are  more  liable 
to  contract  the  plague  than  those  who  wear  boots  and  shoes. 

Dead  rats  are  invariably  found  before  an  epidemic  of  plague 
breaks  out.  The  importance  of  notifying  any  unusual  mortality  or 
sickness  amongst  these  animals  is  not  only  advisable,  but  is  a  duty 
cast  on  every  citizen  of  the  community.  Citizens  of  Kingston 
keep  well  in  mind  the  following  rules,  and  carry  them  out : — 

1.  Exterminate  all  rats  and  mice. 

2.  Keep  your  yards  and  houses  clean  and  sanitary. 

3.  The  keeping  of  cats  and  dogs  is  recommended. 

.  4.  Get  and  keep  in  touch  with  the  sanitary  inspector  for 
the  district  in  which  you  live. 

This  appeal  is  issued  at  the  instance  of  the  special  committee 
appointed  by  His  Excellency  the  G-overnor,  for  the  destruction 
of  rats. 

EOBT.   JOHN'STONE, 
Acting  Colonial  Secretary. 


THE  RAT  ORDINANCE,  GRENADA,  1909 

Regulations  Jor  the  Destruction  of  Rats,  etc.,  on  Vessels. 

1.  Any  medical  officer  on  becoming  aware,  or  upon  suspecting 
that  any  vessel  lying  within  any  waters  of  the  colony  is  infested 
with  rats  or  other  vermin,  is  hereby  empowered  to  strictly  enforce 
the  adoption  of  such  measures  as  may  in  his  discretion  ba  deemed 
most  efficacious  for  the  purpose  of  exterminating  the  said  rats  or 
vermin,  and  of  preventing  such  rats  or  vermin  passing  from  such 


APPENDIX  E  287 

vessel  to   the   shore,  or  from   the   shore  to  such  vessel.     Such 
measures  may  include  the  following : — 

(a)  Eequire  the  owner,  master,  or  person  in  charge  of  the 

vessel  when  at  any  mooring,  or  when  loading  or 
unloading  cargo  at  any  port  within  the  colony,  to  use 
rat-guards  of  a  pattern  approved  by  the  said  officer  on 
every  rope,  cable,  or  such-like  communication  passing 
between  such  vessel  and  the  shore,  or  between  the 
vessel  and  any  lighter  or  barge  or  other  vessel,  or 
between  the  vessel  and  its  buoys  or  anchors,  or  the 
moorings. 

(b)  Require  the  owner,  master,  or  person  in  charge  to  gener- 

ally abate  all  insanitary  conditions  where  they  exist, 
and  to  effectually  remove  or  burn  all  rubbish  and 
deposits  on  the  vessel  likely  to  harbour  rats  or 
vermin. 

(c)  "Whenever  it  shall  appear  to  the  medical  officer  that  the 

rats  or  vermin  can  only  be  exterminated  by  cleansing 
and  disinfection  in  a  specified  manner,  the  medical 
officer  may,  by  notice  in  writing,  either  require  the 
owner,  master,  or  person  in  charge  of  the  vessel  to 
cleanse  and  disinfect  or  fumigate  the  same  accord- 
ingly, or  may  inform  such  owner,  master,  or  person 
that  it  is  the  intention  of  the  medical  officer  to 
conduct  such  cleansing  and  disinfection  or  fumigation 
at  a  time  to  be  specified  in  the  notice. 

2.  "Where  the  owner,  master,  or  person  in  charge  of  such 
vessel  fails  to  comply  with  any  requirements  made  under  these 
regulations,  or  is,  from  poverty  or  otherwise,  unable  to  effectually 
carry  out  such  requirements,  the  medical  officer  may  cause 
the  requisite  measures  to  be  taken  forthwith,  and  the  expenses 
thereby  incurred  may,  at  the  discretion  of  the  General  Board  of 
Health,  be  either  defrayed  from  general  revenue,  or  be  recovered 
wholly  or  in  part  from  such  owner,  master,  or  person. 

3.  It  shall  be  the  duty  of  all  port,  revenue,  and  police  officers 


288  APPENDIX  E 

to  assist   the  medical  oJEficers  in  enforcing  the  provision  of,  and 
preventing  any  infringement  of,  these  regulations. 

4.  Any  person  acting  in  violation  of  these  regulations,  either 
by  way  of  refusing  to  obey  any  requisition  or  instruction  made 
or  given  hereunder,  or  by  obstructing  in  any  way  the  due 
execution  of  these  regulations,  renders  himself  liable  to  a  fine  not 
exceeding  £5. 

Made  by  the  Governor  in  Council,  this  21st  day  of  June  1909. 

T.  T.  Dyee, 

Clerk  of  the  Council. 

In  British  Guiana  and  Trinidad,  measures  have  been  taken 
against  rats  by  the  regular  collection  and  destruction  of  town 
refuse  and  by  the  use  of  rat  poisons. 

In  British  Guiana,  I  pointed  out  that  the  removal  of  the 
superabundant  bush  wliich  had  grown  up  in  the  towns  would 
materially  assist  this  work,  and  I  have  reason  to  believe  the 
suggestion  has  been  acted  upon. 

In  Trinidad,  special  regulations  dealing  with  plague  were  made 
in  August  1907.  A  campaign  against  rats  was  also  instituted,  as 
is  seen  from  the  following  extract  from  a  report  of  the  Surgeon- 
General  : — 

Since  the  30th  May  1906,  there  has  been  eighteen  cases  of 
plague  and  fourteen  deaths  in  Port  of  Spain ;  the  last  two  cases 
occurred  on  the  4th  and  26th  July  respectively — the  last  death 
on  the  28th  July ;  and  the  last  convalescent  case  was  discharged 
from  the  Isolation  Hospital  cured  on  the  13th  inst. 

There  have  been  caught  only  five  infected  rats  (about  0-2  per 
cent.),  all  within  the  infected  area  of  the  town ;  the  last  infected 
rat  caught  was  on  the  17th  July. 

All  the  inspecting  medical  officers  report  vastly  improved 
sanitary  conditions  of  the  premises  within  the  infected  area,  which 
continues  to  be  kept  under  very  close  medical  and  sanitary 
supervision,  and  the  campaign  against  rats  is  actively  maintained 
by  poisons  and  traps  in  charge  of  special  officers  and  gangs  and 
by  rewards  of  5  cents  per  head  for  each  rat,  alive  or  dead, 
delivered  under  certain  conditions. 


APPENDIX  E  289 

As  regards  shipping,  vigilance  continues  to  be  exercised  over 
arrivals  and  departures  from  here — with  special  reference  to  the 
prevention  of  access  to  vessels  by  rats,  the  use  of  rat-guards  of 
efficient  pattern  being  enforced,  and  vessels  anchored  less  than 
two  miles  from  shore  are  prohibited  from  working  cargo  except 
during  daytime,  etc.  It  is  not  proposed  at  present  to  relax  any 
of  the  precautionary  measures  in  operation  for  maintenance  of 
the  good  sanitary  condition  of  the  town  or  for  the  prevention  of 
the  spread  of  infection  (should  any  still  exist  here)  to  other 
countries. 

Amongst  the  measures  which -have  operated  to  reduce  the  rat 
nuisance  in  Trinidad  are  undoubtedly  the  increased  sanitary 
inspection  of  the  town,  the  cementing  of  backyards,  and  the 
removal  of  rubbish. 

In  the  new  draft  Health  Ordinance  1909,  clauses  of  an  up-to- 
date  character  are  to  be  inserted  dealing  with  the  prevention  of 
plague. 


APPENDIX  F 

ERUPTIVE  FEVER;  VARICELLA;  VARIOLOID  VARI- 
CELLA; ABORTIVE,  IRREGULAR,  OR  ATYPICAL 
SMALLPOX;  GIANT  CHICKENPOX;  CUBAN  ITCH; 
VARIOLA- AMBULANS ;  IMPETIGO  CONTAGIOSA 

Under  these  headings  are  grouped  certain  diseases  of  the  small- 
pox type  which  require  investigation.  They  are  a  source  of 
great  difi&culty,  for  by  some  they  are  considered  to  be  genuine 
cases  of  smallpox  and  by  others  not.  The  result  is  that  difficulty 
arises  upon  the  necessity  or  advisability  of  notification  for  inter- 
colonial quarantine  purposes.  In  my  opinion,  these  diseases  are  of 
much  scientific  interest,  and  would  well  repay  investigation ;  for 
whatever  their  nature,  they  appear  widely  distributed,  and  have 
been  described  in  the  United  States  and  in  Canada ;  they  have 
also  been  observed  in  Venezuela,  Trinidad,  and  Grenada,  and  in 
other  places, 

Drs  Dickson  and  Lassalle  have  furnished  an  interesting 
report  upon  the  epidemic  in  Trinidad  of  1902  to  1903.  These 
officers  investigated  4029  cases,  and  furnish  tables  showing  the 
incidence  of  the  disease  amongst  the  vaccinated  and  unvaccinated. 
In  their  opinion,  recent  vaccination  and  re  vaccination  protects  from 
the  disease,  although  their  tables  show  the  occurrence  of  the 
disease  almost  equally  amongst  the  vaccinated  and  unvaccinated. 
The  Surgeon-General  of  Trinidad  states  that  the  disease  was 
probably  introduced  into  that  island  from  Venezuela,  as  the  same 
disease  was  reported  in  the  coastal  villages  of  Venezuela.  As 
there  is  a  large  daily  passenger  and  freight  traffic  between  the 
Port  of  Spain  and  the  villages  on  the  adjacent  Venezuelan  coast, 

290 


APPENDIX  F  291 

this  would  appear  to  be  a  reasonable  view.  Two  medical  men 
were  sent  over  to  Venezuela  to  investigate  the  outbreak ;  they 
visited  Yrapa  and  Guiria,  and  reported  that  the  disease  which 
existed  there  was  very  mild,  and  that  it  went  under  the  Spanish 
name  of  "Lechina"  (chickenpox).  In  proof  of  its  mildness,  it 
was  stated  that  many  of  the  troopers  appeared  under  arms 
covered  with  the  eruption.  Europeans  did  not  appear  to  be 
attacked.  Dr  E.  Seheult  of  Trinidad  has  published  an  excellent 
monograph  with  illustrations  of  the  Trinidad  epidemic  of  1902  to 
1904,  in  which  he  comments  upon  similar  outbreaks  which  have 
been  described  in  other  countries,  notably  in  Canada  and  in  the 
United  States,  Jamaica,  and  Barbados. 

In  Grenada  I  had  an  opportunity  of  discussing  the  disease 
with  Dr  Bennett,  who  has  furnished  a  very  clear  report  upon  71 
cases  of  the  disease.  As  a  result  of  his  experience,  he  concludes 
that  the  disease  resembles  smallpox  more  closely  than  any  other 
of  the  recognised  specific  febrile  diseases,  but  that  it  is  certainly 
not  the  "  smallpox  "  of  our  forefathers.  He  also  observed  that 
more  vaccinated  persons  were  attacked  than  unvaccinated,  and 
several  within  a  year  after  vaccination.  Vaccination,  however, 
had  a  marked  controlling  influence  over  the  course  of  the  disease ; 
the  rash,  for  example,  was  cut  short. 

The  Colonial  Secretary  at  the  time  of  the  epidemic  drew  the 
attention  of  the  medical  officers  to  the  occurrence  of  a  similar 
disease  in  Ontario,  Canada. 


APPENDIX  G 

HEALTH  PROGRESS  IN  THE   FRENCH  WEST  INDIES, 
MARTINIQUE,  AND  GUADELOUPE 

An  outbreak  of  yellow  fever  having  occurred  in  Martinique,  1908- 
1909,  a  committee  of  French  medical  experts  ^  was  sent  out  to 
investigate  the  epidemic.  Thanks  to  their  reports,  which  have 
quite  recently  been  published,  we  are  in  a  position  to  compare 
this  yellow  fever  outbreak  with  those  which  took  place  almost 
simultaneously  in  the  British  West  Indies,  and  which  I  have 
discussed  in  the  preceding  chapters.  We  are,  moreover,  enabled 
to  see  how  far  the  general  anti-yellow  fever  and  antimosquito 
regulations,  as  put  into  operation  in  the  French  Colonies,  corre- 
spond with  those  practised  in  British  Colonies.  The  epidemic 
was  confined  to  Martinique,  and  for  this  reason  the  Commission 
gives  us  no  information  regarding  the  sanitary  conditions  prevail- 
ing in  Guadeloupe,  nor  the  distribution  of  the  Stegomyia  in  that 
island.  This  is  a  pity,  for  every  effort  should  now  be  made  to 
unify  the  regulations  against  stagnant  water,  in  order  to  bring 
about  the  elimination  of  yellow  fever  and  malaria  from  the 
West  Indies. 


Yellow  Fever  in  Martinique  and  Guadeloupe  in  the  Past. 

Like  the  other  islands  of  the  Antilles,  these  colonies  were  no 
doubt  endemic  centres  of  yellow  fever.  We  know  that  a  large 
epidemic    occurred  in    1735    at    St  Pierre   in  Guadeloupe,  and 

^  Dra  Simond,  Aubert,  Grimaud  and  Noc,  Annates  de  L'Instittit  Pasteur, 
Nov.  and  Dec.  1909 ;  and  AtmcUes  d'Hygiene  et  de  Medecine  coloniale, 
1909. 


APPENDIX   G  293 

Pere  Labat  described  the  epidemic  of  1649  which  passed  over 
Martinique,  and  was  then  known  as  the  Maladie  de  Siam,  the 
disease  having  been  supposed  to  have  been  introduced  from  Siam. 
In  the  years  1816  and  1821,  epidemics  are  also  described  in 
Guadeloupe.  The  report  of  the  recent  French  Commission  also 
makes  it  clear  that  yellow  fever  has  been  endemic  until  recent 
times ;  large  outbreaks  occurred  at  certain  periods,  as,  for  example, 
in  the  years  1850-1853,  1855-1857,  1887-1888,  and  in  1895,  but 
in  the  intervals  there  was  reason  to  believe  that  siispicious  cases, 
in  all  probability  mild  forms  of  yellow  fever,  occurred  continuously 
up  to  the  recent  1908-1909  outbreak. 

It  would  appear  evident  from  this,  that  Martinique  was  an 
endemic  focus  until  quite  recently,  and  that  the  disease  manifested 
itself  in  the  Creole  population  in  a  particularly  mild  form,  the 
so-called  "inflammatory  fever,"  an  attack  sufficient  to  confer 
partial  immunity  upon  those  affected,  but  able  to  fully  infect  the 
Stegomyia. 

It  is  worthy  of  note,  in  view  of  what  has  already  been  said 
concerning  the  periodicity  of  yellow  fever  outbreaks,  that  the 
previous  large  outbreak  of  the  disease  occurred  in  1895. 


History  of  the  Recent  1908-1909  Outhreak 

The  Commissioners  state  that  whilst  the  local  medical  men 
were  inclined  to  believe  in  the  local  origin  of  the  yellow  fever, 
they  thought  that  the  disease  might  have  been  in  some  mysterious 
way  revivified  or  augmented.  This  is  only  a  survival  in  the 
minds  of  the  local  medical  men  of  the  old  miasm  theory,  and  is 
one  which  I  have  several  times  encountered  in  the  West  Indies. 

The  Commissioners  investigated  the  probabilities  of  the 
introduction  of  the  disease  from  without,  and  in  their  report 
refer  to  the  parallel  outbreaks  of  yellow  fever  in  Trinidad, 
Barbados,  and  Surinam. 

Upon  the  whole  evidence,  they  conclude  in  favour  of  the  local 
origin  of  the  disease,  a  circumstance  which  is  exceedingly  interest- 
ing to  the  student  of  yellow  fever. 

The  epidemic  broke  out  in  Fort-de-France,  and  from  thence 
spread  to  all  parts  of  the  island. 


294  APPENDIX   G 

There  appears  to  be  no  doubt  that  there  were  very  numerous 
mild  cases  of  yellow  fever,  diagnosed  as  "inflammatory  fever," 
amongst  the  native  Creole  inhabitants,  which  were  entirely  over- 
looked, but  which,  nevertheless,  infected  the  Stegomyias,  and  these 
in  their  turn  infected  the  non-immunes,  especially  those  more 
recently  arrived. 

During  the  epidemic  there  was  an  excellent  opportunity  of 
observing  the  effect  of  antistegomyia  measures  at  Balata  Camp. 
Previous  to  sending  the  soldiers  to  this  station,  there  had  been 
a  vigorous  antilarval  crusade  organised  by  Colonel  Eoulet,  and 
as  a  result  there  were  very  few  cases  of  fever  amongst  the  men, 
and  the  few  cases  which  did  occur  could  be  traced  to  infection 
contracted  outside  the  camp,  either  at  Fort  de  France  or  in  the 
houses  of  natives  scattered  along  the  roads  leading  up  to  the 
camp.  On  the  other  hand,  outside  the  camp,  in  the  houses  of  the 
natives,  where  there  existed  abundant  breeding  places  of  the 
larvae,  yellow  fever  continued  and  spread. 

The  total  number  of  certain  cases  is  given  as  206  from 
February  1908  to  February  1909,  but  in  all  probability  there 
were  far  more  cases  which  assumed  a  very  mild  type,  especially 
amongst  the  children.  These  may  have  amounted  to  922  cases. 
The  observers  lay  quite  rightly  very  great  stress  upon  the  mild 
cases  of  fever  amongst  the  young  Creole  population,  cases  which 
would  be  sure  to  escape  detection,  but  which,  nevertheless,  would 
cause  Stegomyia  infection.  They  also  point  out  how  in  certain 
districts  a  good  water-supply  had  brought  about  a  very  material 
reduction  in  the  total  number  of  breeding  places  of  the  Stegomyia, 
and  in  consequence  a  comparative  immunity  from  the  disease. 

The  Commissioners  point  out  that  the  epidemic  occurred  at 
first  in  a  mild  form  amongst  the  Creoles,  followed  later  by  deaths 
amongst  the  Europeans.  They  also  discuss  the  question  whether 
mild  cases  of  yellow  fever  existed  previously  amongst  the  native 
Creoles,  and  they  conclude  that  a  mild  form  has  probably  always 
existed  amongst  them,  mild  enough  to  give  rise  to  a  partial 
though  not  complete  immunity;  and  in  support  of  this,  they 
mention  that  it  is  a  well-known  observation  that  Creoles  who 
are  long  absent  from  the  island  lose  their  immunity.  They 
also  discuss  the  question  of  recurrence,  and  regard  the  Martinique 
epidemic  as  supporting  the  opinion  that  had  already  been  arrived 


APPENDIX   G  295 

at  in  Brazil  by  Simond  and  Marchoux — namely,  that  reciuTences 
could  take  place,  especially  amongst  those  who,  when  they  were 
young,  had  had  mild  attacks  which  were  probably  diagnosed  as 
some  other  fever.  In  these  cases,  the  secondary  attacks  were 
mild,  and  were  precisely  the  cases  which  in  the  Creoles  were 
diagnosed  as  inflammatory  fever.  They  also  state,  however,  that 
they  noted  some  recurrences  amongst  Europeans.  They  lay  stress 
upon  the  question  of  recurrences,  and  in  support  of  it,  mention 
the  well-known  facts  about  recurrences  in  connection  with  typhoid 
and  other  infectious  diseases :  that  is  to  say,  that  there  are  various 
degrees  of  immunity.  This  contention  is  all  in  support  of  the 
presence  in  endemic  centres  of  disease  of  the  so-called  chronic  or 
ambulatory  cases  of  yellow  fever  to  which  we  have  previously 
drawn  attention,  and  which  are  in  all  endemic  centres  the  source 
of  the  infection  for  the  new  arrivals. 

-Just  as  in  the  case  of  Barbados,  where  vigorous  antilarval 
measures  and  fumigation  led  to  the  suppression  of  the  fever  at 
an  early  date  in  Bridgetown,  whilst  it  persisted  in  the  country 
districts,  so  also  in  Martinique.  In  Fort-de-Erance,  owing  to 
more  active  and  controlled  antimosquito  measures,  the  fever  was 
stopped  in  December  1908.  On  the  other  hand,  it  persisted  till 
February  1909  in  the  outside  districts,  where  antimosquito 
measures  were  less  perfect. 


Prophylactic  Measwes. 

It  does  not  appear  from  the  report  that  previous  to  the 
mission  there  existed  in  the  island  any  antilarval  ordinances 
similar  to  those  in  many  of  the  British  West  Indian  Islands. 
The  Commission  therefore  started  at  once  to  educate  the  public 
— to  co-operate  with  them  and  the  Government.  A  brigade  was 
organised  and  house-to-house  inspections  made ;  all  water  recep- 
tacles were  carefully  examined,  as  also  the  gutters  of  the  houses. 
By  an  order  of  the  Governor,  made  in  December  1908,  all  houses 
were  regularly  inspected  and  water  containing  larvae  thrown 
away,  and  the  occupants  were  instructed  to  change  drinking- 
water  at  least  once  a  week,  and  to  thoroughly  clean  the  receptacles 
each  time. 


296  APPENDIX   G 

They  were  ordered  to  clean  out  all  gutters  and  to  bury  all  odd 
receptacles.  Oil  was  put  into  all  stagnant  water,  and  frequent 
visits  were  paid  to  the  houses  to  see  how  far  the  order  had  been 
obeyed.  The  measures  taken  to  destroy  the  adult  Stegomyia  in 
houses  where  cases  of  yellow  fever  had  occurred  were  the  usual 
ones.  The  result  of  the  antilarval  measures  and  fumigation  was 
to  produce  a  very  noticeable  reduction  in  the  number  of  mosquitos. 
The  report  does  not  say  whether,  as  the  result  of  the  mission, 
permanent  antilarval  measures  were  introduced.  As  the  future 
security  of  the  island  will  entirely  depend  upon  this  action,  it 
is  to  be  hoped  that  the  French  authorities  will  make  it  an  offence 
to  keep  stagnant  water,  as  in  the  case  of  other  islands  of  the 
Antilles. 

ANTIMOSQUITO  LAWS. 

As  the  result  of  a  report  from  the  Minister  of  the  Colonies, 
pointing  out  the  inadequacy  of  the  existing  local  laws  to  meet 
the  emergency  in  the  island,  and  that  up-to-date  regulations  were 
necessary,  the  following  decree  was  signed  by  the  President  of 
the  French  Eepublic : — 

Le   PrI^SIDENT  DE   la  El^PUBLIQUE   FEANCAISE. 

Vu  le  s^natus-consulte  du  3  mai  1854 ; 

Vu  la  loi  du  3  mars  1822  sur  la  police  sanitaire ; 

Vu  la  loi  du  30  novembre  1892  sur  Texercice  de  la  m^decine ; 

Vu  le  d^cret  du  17  aout  1897,  portant  r^glement  d'administra- 
tion  publique  pour  I'application  aux  colonies  de  la  loi  du  30 
novembre  1892  sur  I'exercice  de  la  m^decine ; 

Sur  le  rapport  du  ministre  des  colonies. 

D^crete : 

Art.  1®'. — La  colonie  de  la  Martinique  est  soumise  temporaire- 
ment  au  regime  sanitaire  tel  qu'il  est  d^termin^  par  I'article  1®'  de 
la  loi  du  3  mars  1822  sur  la  police  sanitaire. 

Art.  2. — Le  gouverneur  determine  par  arrete : — 
1°.  Les  precautions  a  prendre  pour  pr^venir  ou  faire  cesser  les 
maladies  transmissibles,  et  notamment  la  fi^vre  jaune,  et  sp^ciale- 
ment  les  mesures   d'isolement  obligatoire  des  malades  dans  les 


APPENDIX   G  297 

locaux  affectes  a  cet  usage,  clans  les  cas  oii  I'autorit^  sanitaire  le 
jugera  necessaire ;  les  mesures  de  desinfection  ou  meme  de  des- 
truction des  maisons  dont  la  desinfection  aura  ete  reconnue  im- 
possible, et  dont  la  conservation  constituerait  un  danger  permanent; 
de  desinfection  ou  de  destruction  des  objets  a  I'usage  des  malades 
ou  qui  ont  ^te  souilles  par  eux,  et  generalement  des  objets  quel- 
conques  peuvent  servir  de  vehicule  a  la  contagion ; 

2°.  Les  prescriptions  destinees  a  assurer  la  salubrity  des 
maisons  et  de  leurs  dependances,  des  voies  privees  closes  ou  non 
a  leurs  extremites,  des  logements  loues  en  garni  et  des  autres 
agglomerations,  quelle  qu'en  soit  la  nature,  notamment  les  pre- 
scriptions relatives  a  I'alimentation  en  eau  potable  ou  a  I'evacua- 
tion  des  matieres  usees,  a  la  destruction  des  rats,  des  moustiques 
et  des  autres  insectes  dangereux  pour  la  salubrite  publique. 

Art.  3. — Le  gouverneur  regie,  par  arrete,  les  attributions,  la 
composition,  la  competence  des  autorit^s  et  le  resaort  des  adminis- 
trations chargees  de  I'execution  de  ces  mesures,  et  leur  delegue, 
pour  un  temps  determine  le  pouvoir  de  les  executer. 

L'arrete  doit  specifier  les  conditions  et  moyens  financiers 
d'execution  de  ces  mesures.  Ces  arretes  sont  immediatement 
executoires. 

Art.  4. — Lorsque  I'insalubrite  d'un  immeuble  est  le  resultat  de 
causes  ext^rieures  et  permanentes  ou  lorsque  les  causes  d'insalu- 
brite  ne  peuvent  etre  detruites  que  par  des  travaux  d'ensemble, 
la  commune  ou  la  colonie,  suivant  les  cas,  pent  acquerir,  apres 
expropriation,  suivant  la  legislation  locale,  la  totalite  des  pro- 
prietes  comprises  dans  le  perimetre  des  travaux;  les  portions  de 
ces  proprietes  qui,  apres  assainissement  opere,  resteraient  en 
dehors  des  aKgnements  arretes  par  les  nouvelles  constructions, 
peuvent  etre  vendues  aux  encheres  publiques,  sans  aucun  droit  de 
preemption  pour  les  anciens  proprietaires  ou  leurs  ayants  droit. 

Art.  5. — Sera  puni  d'un  emprisonnement  de  trois  a  quinze 
jours  et  d'une  amende  de  5  a  50  fr.  quiconque  aurait  contrevenu, 
en  matiere  sanitaire,  aux  reglements  generaux  et  locaux,  aux 
ordres  des  autorites  competentes. 

Art.  6. — La  loi  du  3  mars  1822  et  le  present  decret  seront 
publics  et  affiches  dans  toutes  les  communes  du  territoire  de  la 
Martinique. 


298  APPENDIX   G 

Art.  7. — Le  ministre  des  colonies  et  le  gouverneur  de  la 
Martinique  sont  delegu^s  conform^ment  a  Tarticle  l^'^  de  la  loi  du 
3  mars  1822,  pour  assurer  I'execution  du  present  decret,  qui  sera 
publi(5  au  Journal  offieiel  de  la  E^publique  fran9aise,  au  Bulletin 
des  lois  et  au  Journal  qfflciel  de  la  colonie. 

Fait  a  Paris,  le  11  novembre  1908. 

A.   FALLli:RES. 
Par  le  President  de  la  E^publique : 

Le  ministre  des  colonies, 

Millies  Lacroix. 


APPENDIX   H 

HEALTH   PROGRESS   IN   THE   REPUBLIC   OF 
CUBA  AND   IN   PORTO   RICO 

It  is  in  these  islands  that  the  most  brilliant  and  instructive 
results  of  sanitary  reform  are  met  with.  The  sanitary  reforma- 
tion of  Havana,  and  indeed  of  the  whole  of  Cuba,  has  now  become 
one  of  the  historic  examples  of  the  practical  value  of  sanitation, 
whilst  the  reports  upon  the  prevention  of  tropical  anaemia  in 
Porto  Rico  are  a  model  to  all  the  other  Antilles. 


Republic  of  Cuba. 

In  April  of  last  year,  1909,  there  was  issued  the  first  number 
of  the  official  journal  of  the  Department  of  Public  Health  and 
Charities.  In  this  most  excellent  scientific  publication,  reports 
are  regularly  issued  upon  all  matters  of  interest  to  the  Public 
Health  of  the  Colony,  including  accounts  of  all  the  chief  diseases 
and  the  methods  employed  to  get  rid  of  them.  These  embrace 
antimosquito  measures,  vaccination,  isolation,  hospitals  and  dis- 
pensaries, nursing  staff;  training  of  sanitary  inspectors  and 
nurses;  education  of  the  public;  teaching  of  hygiene  in  the 
schools;  organisation  against  tuberculosis.  Researches  are  also 
carried  out  in  tropical  diseases. 

The  advance  in  sanitary  reform  has  been  strikingly  rapid, 
and  dates  from  1898.  Up  to  this  date,  as  the  journal  states,  the 
Government  had,  during  a  period  of  400  years,  failed  not  only  to 
govern  and  to  civilise  the  native  inhabitants,  but  sanitary  and 
charitable  organisations  were  left  to  take  care  of  themselves. 

It  was  not  to  be  wondered  at  that,  in  the  year  1898,  smallpox, 


300  APPENDIX   H 

malaria,  yellow  fever,  scarlet  fever,  glanders,  diphtheria,  and 
tuberculosis  were  exceedingly  prevalent  throughout  the  island. 
Havana  was  a  pest-house,  one  of  the  notorious  endemic  centres  of 
yellow  fever.  Indeed  yellow  fever  has  been  known  in  Cuba  from 
the  earliest  times.  In  1620,  the  disease  went  under  the  name  of 
the  Pest  of  Havana,  and  it  remained  endemic  up  till  1900 ;  yet, 
when  the  first  number  of  the  official  journal  appeared  in  May 
1909,  Dr  John  Guiteras  wrote:  "Prosperous  indeed  are  the 
auspices  under  which  the  first  number  of  the  Public  Health  and 
Charities  Bulletin  appears,  announcing  that  the  territory  of  the 
Eepublic  is  entirely  free  from  smallpox,  yellow  fever,  and  the 
bubonic  plague ! " 

What  were  the  forces  which  brought  about  this  sanitary 
revolution  in  a  population  of  1,570,000  souls  ? 

In  1898,  the  American  Government  assumed  the  administra- 
tion and  organised  the  Public  Health  administration,  with  the 
assistance  of  Gorgas,  General  Wood,  Kean,  Finlay,  Guiteras. 

One  of  the  first  acts  of  the  new  administration  was  to  appoint 
a  commission  to  find  out  what  was  yellow  fever. 

We  all  now  know  that  the  young  medical  officers  who  were 
appointed — namely,  Eeed,  Carrol,  Agramonte,  and  Lazear — proved 
to  the  world  how  yellow  fever  was  carried.  It  was  by  acting 
upon  these  experiments  that  yellow  fever  had  ceased  to  be 
endemic  in  the  island  for  the  first  time  in  history,  and  that  it 
can  be  said  that  to-day  deaths  occur  in  Cuba  in  the  same  propor- 
tion as  in  cold  or  temperate  countries,  where  most  scrupulous 
hygienic  measures  are  in  force  ! 

All  this  has  been  largely  the  result  of  unconditional  war  upon 
the  mosquito.  Does  an  island  in  the  Antilles  still  exist  which 
requires  a  more  convincing  demonstration  ? 

Colonel  Kean  remained  adviser  to  the  Sanitary  Department 
of  Cuba  until  the  commencement  of  1909.  Then  the  Department 
of  Health  and  Charities  of  the  Eepublic  of  Cuba  was  founded. 
It  is  a  Department  of  the  Government,  and  there  are  connected 
with  it  eighty-two  local  health  officers  for  the  various  provinces, 
and  in  addition,  medical  officers  of  health  for  Havana  itself,  and 
some  twenty-five  physicians  employed  in  various  capacities. 

There  is  also  a  National  Board  of  Health  and  Charities,  com- 
posed of  a  Board  of  thirteen  members,  with  an  honorary  President. 


APPENDIX   H  301 

It  is  an  advisory  body,  which  recommends  or  reports  to  the 
Secretary  of  the  Department  of  Health  and  Charities.  The 
Secretary  to  the  Department  is  Dr  Matias  Duque.  Dr  Duque, 
in  stating  his  reasons  for  the  publication  of  the  of&cial  bulletin, 
says  the  publication  has  a  twofold  object:  "First,  to  carry  out 
the  provisions  of  the  law;  and,  secondly,  to  place  ourselves  in 
contact  with  the  rest  of  the  world,  in  order  to  let  it  know  what 
we  are  doing  for  health  and  charity.  .  .  .  We  are  obliged  to  main- 
tain a  good  sanitary  condition  in  our  own  interest,  for  our  national 
pride,  as  altruism  toward  the  men  of  other  lands,  who  should 
come  to  our  shores  without  any  apprehensions,  and  in  order  that 
we  may  be  received  in  theirs  without  fear  that  we  may  carry 
transmissible  diseases.  This  is  the  only  reason  why  we  consider 
ourselves  bound  to  preserve  the  public  health  at  any  cost." 

Could  a  young  repubhc  start  on  its  career  with  finer  aspira- 
tions ?  Let  us  hope  that  the  other  islands  of  the  Antilles  will 
follow  the  splendid  example  of  the  "  Pearl "  of  the  group. 


Porto  Rico. 

Once  an  endemic  focus  of  fevers  has  now  been  brought  into 
line,  and  one  of  the  most  brilliant  reforms  has  been  the  appoint- 
ment of  a  permanent  Commission  for  the  suppression  of  unci- 
nariasis or  tropical  anaemia  in  the  year  1905.  Previously  to 
that  date,  in  1904,  however,  investigations  had  been  commenced. 

This  Commission  has  presented  two  most  excellent  reports 
dealing  with  the  causes  of  the  disease,  and  the  methods  of  pre- 
vention and  treatment. 

The  reader  is  recommended  to  consult  the  reports  published 
in  1905  and  1907  for  full  particulars  of  the  plan  of  campaign. 
It  is  sufficient  to  know  in  this  place  that  the  results  are  excel- 
lent, and  that  the  methods  of  prevention  should  be  closely  studied 
by  those  colonies  desirous  of  getting  rid  of  ankylostomiasis. 


APPENDIX  I 
HEALTH  PROGRESS  IN  JAMAICA 

As  in  the  case  of  the  other  islands,  Jamaica  was  at  one  time 
an  endemic  focus  of  yellow  fever  {vide  Chapter  II.). 

Vast  improvements  have,  however,  been  made  in  sanitary 
administration,  and  endemic  yellow  fever  has  been  stopped. 

Considerable  attentioa  has  also  been  paid  to  antiplague 
measures,  as  we  have  already  seen  in  the  Appendix.  A  great 
deal  yet  remains  to  be  accomplished  in  getting  rid  of  insect- 
carried  diseases,  and  recently  a  Report  ^  has  been  issued  by  a 
small  commission  sent  out  by  the  Liverpool  School  of  Tropical 
Medicine,  in  which  attention  is  drawn  to  the  necessity  of  energetic, 
systematic,  and  well-directed  antimosquito  work  in  order  to 
rid  the  island  of  malaria.  The  Report  consists  of  two  portions, 
one  by  Mr  Newstead,  dealing  with  the  medical  and  economic  ento- 
mology, in  which  a  careful  description  is  given  of  the  ticks  of 
the  island  and  the  diseases  which  they  produce  in  cattle;  also, 
an  account  of  the  natural  enemies  of  the  ticks,  and  the  remedies 
which  should  be  adopted  against  these  pests.  In  the  second 
portion  of  the  Report,  Dr  Prout  deals  with  the  distribution  of 
the  anophelines  in  Jamaica,  and  with  the  prevalence  of  malaria. 

According  to  the  Report,  practically  no  antimalarial  measures 
have  been  undertaken,  and  there  certainly  do  not  appear  to  be 
any  drainage  bye-laws,  or  anti-stagnant  water  ordinances  similar 
to  those  which  exist  in  the  sister  colonies,  This  reveals  a  state 
of  affairs  which  calls  for  early  rectification,  and  it  appears  reason- 
able to  suppose  that  this  will  be  done  under  the  present  Govern- 
ment, for  those  in  charge  of  the  Administration  are  fully  alive 
to  the  importance  of  making  Jamaica  attractive  to  the  tourist, 

1  Annals  of  Tropical  Medicine  and  Parasitology,  Liverpool,  1904. 

302 


APPENDIX  I  303 

as  well  as  to  the  trader,  and  the  Colonial  Secretary  has  already 
had  great  experience  in  antimosquito  work,  both  in  British 
Honduras  and  in  St  Lucia.  At  the  present  time,  judging  from 
the  local  press,  there  appears  to  be  a  general  desire  to  carry  out 
antilarval  operations  oa  a  proper  basis,  so  as  to  bring  Jamaica 
up  to  the  front  rank,  and,  as  I  have  said,  the  auspices  are  ex- 
ceedingly good. 


APPENDIX  J 

HEALTH  PROGRESS  IN  THE  BAHAMAS  AND 
NORTHERN  ISLANDS 

The  Bahamas. 

These  islands  were  also  at  one  time  the  home  of  endemic 
fevers.  Thanks  to  sanitary  reforms,  and  to  wise  legislative 
measures,  as,  for  example,  the  antimosquito  rules  (1907)  of 
Nassau  (Chapter  VI.),  great  improvement  has  taken  place. 


Northern  Islands. 

In  these  islands,  as  we  have  seen  in  Chapter  II.,  yellow  fever 
was  also  very  common.  Vigorous  antimosquito  work  has,  how- 
ever, been  undertaken,  as  we  have  seen,  in  Antigua,  commencing 
in  1904. 


304 


APPENDIX  K 
HEALTH  PROGRESS  IN  BRITISH  HONDURAS 

Although  this  colony  is  on  the  mainland,  yet  it  is  usually 
grouped  with  British  Guiana  and  the  West  India  Islands,  In 
fact  these  colonies  constitute  a  natural  group,  and  for  sanitary, 
administrative,  and  medical  purposes  it  is  desirable  to  study  them 
as  a  whole.  In  1905,  I  visited  the  colony  to  report  upon  an 
outbreak  of  yellow  fever  which  had  occurred,  and  to  suggest 
measures  to  prevent  its  recurrence.^ 

The  numerical  strength  of  the  colony  was  then  small,  so  that 
the  number  of  newcomers  or  non-immunes  must  have  been  very 
small.  The  permanent  population  were  no  doubt  for  the  most  part 
immunes,  having  probably  at  some  time  of  their  life  suffered  from 
yellow  fever  in  a  mild  or  severe  form. 

The  origin  of  the  1905  outbreak  might,  therefore,  be  attribut- 
able to  either  Stegomyia  infected  from  mild,  acute,  or  chronic 
indigenous  unrecognised  cases  of  yellow  fever,  or  from  Stegomyia 
freshly  infected  from  imported  cases  of  yellow  fever.  I  inclined 
to  the  latter  view,  although  I  now  admit  the  possibility  of  the 
former  view. 

My  steps  in  order  to  eradicate  the  Stegomyia  calopus  were 
to  make  a  survey  of  its  breeding  places.  I  then  urged  the 
necessity  of  introducing  water-screening  ordinances,  and  the 
better  supervision  of  all  yards  in  order  to  remove  all  odd  recep- 
tacles which  might  contain  stagnant  water.  I  further  advised 
strict  quarantine  supervision,  and  the  adoption  of  the  United  States 
system  of   sending  a  medical   officer  to  any  suspected  port  to 

^  Report  to  the  Government  of  British  Honduras  upon  the  outbreak  of 
Yellow  Fever  in  that  colony  in  1905. 

306  y 


306  APPENDIX  K 

ascertain  facts,  and  also  to  travel  on  the  ships  in  order  to  keep 
passengers  and  crews  under  observation. 

My  recommendations  were  largely  acted  upon,  and  the  results 
as  judged  by  the  past  five  years  have  been  satisfactory,  for  in  so 
far  as  I  am  aware  no  case  of  yellow  fever  has  occurred  in  Belize, 
and  the  medical  representative  of  the  United  States  Marine 
Hospital  Service  stationed  in  Belize  has,  from  time  to  time, 
reported  marked  diminution  in  the  number  of  Stegomyia,  and  the 
faithful  carrying  out  of  the  screening  regulations,  removal  of  odd 
receptacles,  and  general  sanitary  inspection.  Much  also  has  been 
done  to  render  the  lots  in  Belize  less  waterlogged.  A  most 
interesting  circumstance  occurred  in  1907,  when  dengue  fever 
broke  out  in  the  colony;  the  United  States  Marine  Hospital 
Service  thought  that  it  might  possibly  be  a  yellow  fever  outbreak, 
and  so  sent  their  representative  to  investigate  matters  previous 
to  closing  the  port.  The  representative  reported  after  examina- 
tion that  as  no  Stegomyias  were  to  be  found  in  Belize,  the  disease 
could  not  be  yellow  fever,  and  in  consequence  quarantine  was  not 
imposed  upon  the  port.  Drainage  operations  and  bush-clearing 
has  been  commenced  in  and  around  Behze,  and  the  Medical 
Officer's  Keport  shows  a  distinct  diminution  of  malaria. 


The  Mosquito  Destruction  Ordinance,  1906. 

Be  it  enacted  by  the  Governor  of  British  Honduras,  with  the 
advice  and  consent  of  the  Legislative  Council  thereof : — 

5.  The  owner  or  person  in  control  of  any  cistern  or  vat,  tank, 
barrel,  bucket,  or  other  vessel  used  for  the  storage  of 
water  shall,  within  such  time  as  may  be  specified  by 
notice,  protect  the  same  from  mosquitos  in  the  following 
manner,  that  is  to  say — 

Cisterns,  tanks,  vats,  and  barrels  shall  be  provided 
with  covers  of  wood  or  metal,  and  all  openings  other  than 
the  delivery  exit  shall  be  screened  with  netting ; 

Buckets  and  similar  or  other  containers  shall  be 
protected  in  the  same  way  as  cisterns,  or  in  some  other 
manner  approved  by  the  Board. 


APPENDIX  K  307 

6.  Owners  and  occupiers  of  premises  on  which  there  is  any 
water  in  wells,  ponds,  pools,  or  basins,  or  in  depressions 
or  excavations  made  for  any  purpose,  or  which  by  any 
means  have  occurred,  and  in  which  mosquitos  can  breed, 
shall,  within  such  time  as  may  be  specified  by  notice, 
protect  the  same  from  mosquitos  in  the  following 
manner:   that  is  to  say — 

Stock  them  with  mosquito-destroying  fish ; 

Or  cover  them  with  protective  netting ; 

Or  drain  them  off  at  least  once  every  week ; 

Or  cover  them  with  oil  at  least  once  a  week ; 

Or  fill  them  up ; 

Or  (in  the  case  of  wells)  provide  them  with  a  pump 
and  mosquito-proof  cover  to  the  satisfaction  of  the 
Board. 

7.  All  empty  and  open  tins  shall  be  kept  in  such  a  position  as 

to  prevent  mosquitos  breeding  in  them;  and  all  old 
receptacles,  such  as  jars,  broken  crockery,  condensed- 
milk  tins,  and  other  rubbish  which  form  receptacles  for 
water  shall  be  removed  or  buried.  All  doreys,  pitpans, 
and  boats  in  use  or  discarded  must  be  kept  free  of  fresh 
water.  Odd  receptacles  for  water  to  be  removed  or 
buried,  and  doreys,  pitpans,  and  boats  to  be  kept  free 
of  water. 

8.  A  proper  officer  or  a  health  oflBcer  may,  at  any  time  between 

sunrise  and  sunset,  enter  upon  any  premises,  to  ascertain 
whether  there  exist  breeding  places  for  mosquitos  in  or 
on  such  premises,  or  for  the  performance  of  any  act  or 
thing  which  such  officer  may  hereunder  lawfully  do  or 
perform. 

9.  A  proper  officer  may  at  any  time   treat   stagnant  water 

by  applying  oil  to  its  surface  in  such  a  manner  as  to 
destroy  mosquitos,  provided  that  oil  shall  not  be  put 
into  a  cistern  or  other  water-container  which  is  properly 
screened  from  mosquitos,  and  provided  that  only  refined 
oil  be  placed  in  receptacles  containing  water  used  for 
drinkiner. 


308  APPENDIX  K 

10,  Whenever  it  shall  appear  to  any  Board,  on  the  certificate 

of  a  health  officer,  or  of  any  duly  qualified  medical  prac- 
titioner, that  a  case  of  yellow  fever  has  occurred,  or  that 
a  case  of  fever  has  occurred  of  which  the  diagnosis  is 
doubtful,  but  which  may  possibly  be  one  of  yellow  fever, 
the  Board  shall  order  the  fumigation  of  the  premises  in 
which  such  case  shall  have  occurred,  and  also  of  any 
premises  situated  within  one  hundred  yards  of  the  said 
premises,  and  the  Board  may  order  the  fumigation  of 
such  other  premises  as  on  the  recommendation  of  the 
health  officer  it  may  deem  advisable.  Such  fumigation 
shall  be  carried  out  by  a  proper  officer  under  the  super- 
vision of  a  health  officer. 

11.  Any  owner  or  occupier  failing  to  comply  with  the  require* 

ments  of  this  Ordinance  shall  be  liable  on  summary 
conviction  to  a  fine  not  exceeding  fifty  dollars,  and  to  a 
further  penalty  of  five  dollars  for  every  day  he  continues 
in  default  after  the  expiration  of  the  time  specified  in 
the  notice. 

12.  If  any  person  in  any  manner  whatever  assaults,  resists, 

obstructs,  intimidates,  or  bribes,  or  attempts  to  assault, 
resist,  obstruct,  intimidate,  or  bribe  any  officer  or  health 
officer  acting  in  the  execution  of  his  duty  under  the 
provisions  of  this  Ordinance,  every  such  person  shall  be 
liable  on  summary  conviction  to  a  fine  of  not  exceeding 
fifty  dollars. 

13,  Whenever  any   owner   or   occupier  shall  have  failed  to 

comply  with  a  notice  hereunder,  the  Board  may  direct 
a  proper  officer  to  enter  upon  the  premises  and  carry  out 
such  work  as  may  be  necessary,  and  as  required  by  the 
notice,  and  shall  be  entitled  in  addition  to  proceeding 
for  a  conviction  of  any  offence  committed  hereunder,  to 
recover  the  cost  of  such  work  in  accordance  with  the 
Public  Health  Ordinance.  Provided  nevertheless  that 
where,  in  the  opinion  of  the  Board,  any  owner  or 
occupier  is  from  poverty  or  otherwise  unable  effectually 
to  carry  out  the  requirements  of  any  notice  served  under 


APPENDIX  K  309 

this  Ordinance,  the  Board  may  direct  that  any  cost  or 
expense  incurred  under  this  Ordinance  may  be  defrayed 
Out  of  funds  at  the  disposal  of  the  Board,  or  that  such 
owner  or  occupier  shall  pay  only  so  much  of  the  cost 
and  expense  as  in  the  opinion  of  the  Board  such  owner 
or  occupier  is  able  to  pay, 

14.  This  Ordinance  shall  be  read  together  with  the  Public 

Health  Ordinance,  and  where  not  inconsistent  with  the 
context,  the  provisions  of  the  Public  Health  Ordinance 
shall  apply,  so  far  as  it  is  possible  to  apply  them,  to  the 
subject-matter  of  this  Ordinance. 

15.  All  fines  and  penalties  paid  in  respect  of  non-compliance 

with  this  Ordinance  shall  be  placed  to  the  credit  of  the 
Board  instituting  the  prosecution. 

Wilfred  Collett. 


In  1907  a  most  useful  and  practical  Quarantine  Ordinance 
was  passed,  dealing  with  yellow  fever,  plague,  cholera,  and 
smallpox.  This  Ordinance  has  been  most  efficiently  carried 
out  by  the  Principal  Medical  Ofiicer,  Dr  Harrison.  Every  vessel 
is  boarded,  irrespective  of  whether  it  has  a  foul  or  clean  bill  of 
health. 


THE   ANTIMOSQUITO   CAMPAIGNS   IN  THE 
LATIN  REPUBLICS 

The  modern  sanitary  awakening  and  the  war  on  mosquitos 
has  also  permeated  into  the  Latin  Eepublics  of  Central  and 
Southern  America.  Mexico  is  wonderfully  well  organised.  The 
work  being  now  done  in  the  Canal  Zone  is  rightly  regarded  as 
a  model  for  the  rest  of  the  world,  and  Brazil  has  accomplished 
much,  up  till  now  for  the  most  part  on  the  Pacific  side.  I  have 
reason  to  know,  however,  that,  thanks  to  the  energy  of  Dr  Thomas, 
the  representative  of  the  Liverpool  School  of  Tropical  Medicine, 


310  APPENDIX  K 

and  to  the  various  expeditions  which  that  school  has  sent  out  to 
the  Amazon,  the  antimosquito  measures  at  the  various  ports 
on  that  great  river  are  becoming,  and  will  become,  greatly  im- 
proved, and  that  no  doubt  endemic  yellow  fever  will  disappear. 
Dr  Thomas's  Eeport  upon  his  long  experience  and  researches  in 
connection  with  disease  on  the  Amazon  will  appear  very  shortly.^ 

1  "  Report  of  the  1905-1909  Expedition  to  the  Amazon,  by  H.  Wolferstan 
Thomas,"  Annals  of  Tropical  Medicine^  Liverpool,  vol.  vi.,  1910. 


CONCLUSION 

I  HAVE  brought  forward  sufficient  evidence  in  this  book 
to  conclusively  prove  that  during  the  past  decade  an 
immense  awakening  has  taken  place  over  the  whole  of 
the  yellow  fever  zone  of  the  world,  that  is,  the  West 
Indies  and  on  the  Spanish  Main,  with  regard  to  the 
imperative  necessity  of  an  unconditional  war  against 
insect  pests.  We  have  seen  how  antilarval  bye-laws 
and  ordinances  have  been  put  into  force  in  a  large 
number  of  colonies,  and  how  in  others  there  exist 
drainage  and  stagnant- water  regulations.  We  have  seen 
that  as  a  result  of  these  wise  measures  and  educa- 
tional effort,  yellow  fever  has  ceased  to  be  endemic 
in  very  many  places,  and  is  in  fact  fast  disappearing 
altogether  from  some  localities.  In  connection  with 
malaria,  also,  great  improvements  have  taken  place, 
and  so  also  in  the  case  of  many  other  insect-carried 
diseases.  It  now  remains  for  the  few  colonies  in  the 
zone  which  up  till  now  have  not  moved  vigorously,  to 
fall  into  line,  and  declare  unconditional  war  on  the 
mosquito. 

The  splendid  example  of  the  magnificent  progress 
which  has  been  made  in  the  yellow  fever  zone  should 


312  CONCLUSION 

stimulate  all  tropical  countries  to  follow  suit.  Africa 
has  commenced  in  earnest ;  India,  with  its  overwhelm- 
ing advantages  and  prestige,  should  now  make  every 
effort  to  repeat  what  has  been  done  with  such  marked 
success  in  Cuba,  Panama,  Mexico,  and  Brazil. 


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ETIOLOGY 

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BACTERIA 

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VACCINE 

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TREATMENT,  ETC.  317 

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YELLOW  FEVER  CAMPAIGNS 

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YELLOW  FEVER  IN  FRENCH  GUIANA 

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YELLOW  FEVER  IN  DUTCH  GUIANA,  ETC.      319 

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AFRICA 

De  la  cachexie  palvdeenne  en  Algerie.    M.  Catteloup,  1852. 
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X 


322  GENERAL  BIBLIOGRAPHY 

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EUROPE 

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esta  misma  plaza  y  varias  otras  del  reyno  en  1804.  Don  J.  Manuel 
de  Arejula,  1806. 

Relation  historique  et  medicale  de  la  Fievre  Jav/ne  qui  a  regne  a  Barcelone 
en  1821.    M.  F.  M.  Audouard,  1822. 

ERUPTIVE  FEVERS— LEPROSY 

On  an  Epidemic  of  Small'pox/'^'ljm,  Irregular  Type  in  Trinidad  during 

1902-4.    R.  Seheult.    London,  1908. 
"Mild  and  Irregular  Forms  of  Smallpox."    Herman  Spalding.    Journ. 

Amer.  Med.  ^ss.^August  1901. 
"Notes  on  a  Mild  Type  of  Smallpox."    F.  Montizambert.    Brit.  Med. 

Journ.,  1901,  vol.  i.,  p.  1134. 
"Varioloid  Varicella  in  Jamaica."     Izett  Anderson.     Pro.  Epid.  Soc, 

London,  1867. 
Papers  relating  to  Leprosy  in  certain  British.  Colonies.    Colonial  Ofl&ce, 

1909. 
Studies  upon  Leprosy :  Nature  Treatment.     W.  R.  Brinckerhoff.     8vo. 

Washington,  1909. 

YELLOW  FEVER  IN  UNITED  STATES 

"  The  Cost  of  Yellow  Fever  Epidemics,  and  the  Epidemic  at  Decatur,  Ala, 
1888."    W.  R.  Forest.    Medical  Record,  New  York,  1889,  vol.  xxxv. 

"  An  Account  of  the  Destruction  of  Mosquitos  in  the  '  Original '  Infected 
District  in  the  New  Orleans  Epidemic  of  1905,  together  with  the 
YeUow  Fever  Statistics  of  that  District."  T.  D.  Berry.  Med. 
Record,  1907,  vol.  Ixxii.,  pp.  421-27. 


INDEX 


Agkamonte,  Dr,  26 
Ague,  fever  and,  50 
Amazon,  115,  118 

and  health  progress,  306 

and  yellow  fever,  119,  309 
America,  Central  and  Southern,  309 

health  progress,  306 
Antilarval  bye-laws,  54 

measures,  49-75,  296,  306 
Anaemia,    tropical,    see     Ankylosto- 
miasis 
Ankylostomiasis,  50 

and  Bahamas,  260 

and  Bermuda,  260 

and  British  Guiana,  260,  243,  244, 
245 

circulars  relating  to,  224,  253-263 

and  emigrants,  257 

and  Jamaica,  261 

and  labour,  223 

and  Leeward  Islands,  261 

and  Porto  Rico,  301 

and  St  Lucia,  185,  266 

and  St  Vincent,  172 

and  sugar  estates,  219,220,  221,  223, 
224,  246,  256 

and  Trinidad,  219,  220,  224,  249 

and  West  Indies,  260 

and  Windward  Islands,  262 
Anopheline  mosquitos,  50 
Antigua,  10,  37 

Bahamas,  15 

antilarval  laws,  73 
health  progress  in,  302 


Barbados,  12,  13,  14,  15,  16,  92,  146 
antilarval  laws,  55 
cessation  of  epidemic,  90 
cleaning  up,  122 
climate  of,  143 
commissioners,  127 
and  dengue  fever,  97 
diagnosis  of  early  cases,  92 
difficulties  of  diagnosis,  94,  141 
diseases  in,  143 
division  into  parishes,  127 
early  epidemics,  85 
and  early  notification,  97 
entomologist,  147 
epidemic  jaundice,  96 
filariasis,  146 
fumigation  of  houses,  138 
gastric  influenza,  95 
health  progress,  122 
health  reports,  133 
intimidation  in,  101,  102, 103 
isolation  hospital,  137 
leg,  146 

and  malaria,  82,  97,  144,  145 
medical  administration,  127 
mild  cases,  93 
mortality  returns,  136 
mosquito  destruction,  circulars  re- 
lating to,  268 
mosquito  survey,  122,  124 
need  of  a  medical  officer,  135 
notification  fear,  99 
origin  of  epidemic,  85 
prosecutions,  57,  126 
press  of,  98 


324 


INDEX 


Barbados,  quarantine  administration, 
141,  142 

quarantine  laxity,  113 

quarantine  precautions,  112 

sanitary  administration,  127 

sanitary  system,  129,  131 

sickness  returns,  136 

size  of  epidemic,  91 

source  of  infection,  112 

spread  of  epidemic,  89 

tardy  notification,  105 

water-supply,  125 

"Weil's  disease,  96 

1909  yellow  fever  epidemic,  84 
Beauperthuy,  Dr,  22,  25,  26 
Blackwater  fever  and  Trinidad,  207 
Blair,  Dr,  11,  16 
Branch,  Dr  (the  late),  166 
Bridgetown,  87,  89,  123 
British  Guiana,  2,  16 

Ankylostmniasis,  243 

and  Anophelines,  236 

antilarval  laws,  69 

antimosquito  measures,  237,  239 

Colonial  Hospital,  245 

complaints  against  Barbados,  249 

and  disease  returns,  243 

drainage,  70 

early  history,  yellow  fever,  230 

and  education,  241 

and  entomology,  234 

health  progress,  228 

and  leprosy,  245 

and  malaria,  239,  241 

medical  administration,  247 

mortality  returns,  242 

mosquito  prevention,  69 

and  mosquitos,  235 

quarantine  administration,  247 

sanitary  administration,  245 

and  screening  measures,  241 

on  tardy  notification  of  Barbados. 
247 

vat-screening,  70 
British  Honduras — 

drainage,  306 

and  dengue  fever,  306 


British    Honduras,    health    progress, 
304 
mosquito     destruction    ordinance, 

306,  307,  308,  309 
quarantine  ordinance,  309 
yellow  fever,  305 
Brown,  Dr,  8 
Bulam  fever.  3 
Bulama,  152 

Careoll,  Dr,  26 

Carter,  Dr,  26 
Carthagena,  6 
Chamberlain,  The  Et.  Hon.  Joseph, 

38 
Chisholm,  Dr,  151 

Clare,  Surgeon-General,  201,  206,  211 
Coup  de  harre,  3 
Cuba,  49 

National    Board    of    Health    and 
Charities,  300 

and  Porto  Eico,  health  progress  of, 
299 

sanitary  reform,  299 

and  yellow  fever,  299,  300 
Culicidag,  52 

Dandy  fever,  50 
Dengue  fever  and  Barbados,  97 
Dengue  fever,  53.  306 
Dickson,  Dr  J.  E'.,  206,  207 
Dominica,  10,  11 
Duque,  Dr  Mattias,  301 
Durrant,  Dr  C.  H.,  165 
Du  Tertre,  Pere,  3 
Dutroulau,  Dr.  11 

Education  as  a  prophylactic  factor, 
41 

Fevee  and  ague,  50 

dandy,  50 

dengue,  53,  306 

eruptive,  290 
Filariasis,  50,  53 

and  Barbados,  146 

St  Vincent,  173 


INDEX 


325 


Finlay,  Dr,  26 

Fleas,  53 

Fly,  the  house,  53 

Gastric  Influenza,  95 
Georgetown,  Demerara,  11,  16,  239 

removal  of  bush,  233 

Stegomyia  survey,  232 

yellow  fever,  1 1 
Godfrey,  Surgeon-General,  232 
Grand  Turk,  s.s.,  77 
Grenada,  12,  149 

antilarval  bye-laws,  57 

antilarval  measures,  154,  158,  159 

antimalarial  measures,  158,  159 

antimosquito  measures,  158,  159 

board  of  health,  155 

division  of  island,  154 

early  epidemics  in,  151 

early  history  of  yellow  fever,  151 

and  eruptive  fevers,  160 

health  administration,  154 

health  progress,  149 

and  malaria,  156,  157 

mosquito  survey,  153 

principal  towns,  155 

public  health  ordinance,  59,  156 

rat  ordinance,  286 

recent  cases  of  yellow  fever,  153 

and  tuberculosis,  161 

and  yaws,  160 
Guadeloupe,  2,  11 
Guiteras,  Dr,  45 

Hankey,  ship,  3,  77,  151 
Harrison,  Prof.,  26 

Dr,  309 
Havana,  6,  49 
Hill,  Luke  M.,  232 
Hodder,  Major,  185 
Hook-worm,  53    (see    also   Anhylos- 

tomiasis) 
Hunter,  Dr,  9 

Hutson,  Dr,  89,  95,  108,  109,  123 
Hutson's  report  on  yellow  fever  in 
St  Lucia,  Barbados,  270 


Indefatigable,  H.M.S.,  87,  88 
India,  47,  81 
Inflammatory  fever,  293 
Insect  pests,  49 
Isthmian  Canal,  49 

Jamaica,  8, 16 

antiplague  measures,  285 

health  progress  in,  302 

and  malaria,  302 

and  yellow  fever,  302 
Jaundice,  epidemic.  96 

Kean,  Colonel,  300 

Kendall's  disease,  3 

King,  Dr  A.,  180,  181,  183,  184 

Kingsley,  Charles,  18 

Kingstown,  mosquito  survey,  169 

divisions  of,  163 

St  Vincent,  162 

Labat,  Pere,  3 

Larval,  anti-,  measures,  49-75,  296, 306 

Lassalle,  Dr  C.  M.,  206 

Law,  Dr,  234,  244 

Lazear,  Dr,  26 

Leeward  Islands,  9 

Leprosy,  Barbados,  146 

British  Guiana,  245 

Trinidad,  225 

Mai  de  Siam,  3 
Malaria,  37 

and  Barbados,  82,  97,  143,  144,  145 

and  British  Guiana,  239,  240,  241, 
242,  243 

and  British  Honduras,  306 

and  Grenada,  156,  157,  158 

and  Jamaica,  302 

and  millions,  145,  159 

and  slaves,  82 

and  St  Lucia,  184,  185,  186 

and  St  Vincent,  171,  172 

and  Suez  Canal,  81 

and  sugar  estates,  219,  220 

and  Tobago,  220 

and  Trinidad,  207,  208,  209 


326 


INDEX 


Malaria  and  water-supplies,  37 
Manson,  Sir  Patrick,  26 
Martinique,  10,  11,  115.  295 

antimosquito  laws,  296 

and  health  progress,  292 

history  of  recent  outbreak,  293,  294 

history  of  yellowfever  in  the  past,292 

prophylaxis,  295 
2faranheTi$e,  s.s.,  120 
Maunsell,  Dr,  9 
Montserrat,  10 
Mosquito  -  carried     diseases     in     St 

Lucia,  reports  on,  264,  265 
Mosquitos,  52 
Moxley,  Eev.  Sutton,  26 
Musgrave,  Dr,  10 

Nassau,  15 

antilarval  laws,  73 

Health  Act,  1907,  74 
Xevis,  10 
Xew  Orleans,  49 
Northern  Islands,  health  progress  in, 

304 
Notification,  tardy  circular  on,  276 
Nott,  Dr,  26 

Oriflamme,  s.s.,  3,  77 

Paeasites,  intestinal,  53 
Paterson,  Dr  G.  W.,  153 
Pavy,  Dr,  107 
Pellagra,  143 
Plague,  53,  81,  87 

British  Guiana,  288 

Grenada,  160 

Grenada  Rat  Ordinance,  286,  287 

Jamaica,  anti-,  285 

San  Francisco,  44 

Trinidad,  225,  288,  289 
Plague  measures,  British  Guiana  and 

Trinidad,  288 
Port  of  Spain,  215 
Porto  Pvico,  2 

and  tropical  anaemia,  301 
Bsilosis  pigmentosa,  143 
Puramus,  H.M.S.,  107 


Reed,  Dr,  26 

Rose,  50 
Ross,  Major,  26 

St  Domingo,  2,  11, 16,  116 

St  George,  town  of,  150 

St  Kitts,  10,  14 

St  Lucia,  13,  141,  142 

and  ankjdostomiasis,  185 

antilarval  bye-laws,  63 

antimosquito  measures,  179 

early  epidemics.yellowfever,  174,175 

health  progress,  174 

history  of  yellow  fever,  181 

and  malaria,  184 

mosquito  destruction,  65,  177 

mosquito  survey,  180 

Public  Health  Acts,  176 

quarantine  administration,  183 

and  yaws,  185 
St  Vincent,  13,  115 

ankylostomiasis,  172 

antilarval  bye-laws,  60 

filariasis,  173 

fumigation,  167 

health  administration,  165 

health  progress,  162 

and  malaria,  171 

medical  organisation,  164 

mosquito  survey,  169 

parishes  of,  162 

Public  Health  Acts,  165 

recent  cases,  yellow  fever,  116,  166, 
167 

tuberculosis,  173 
San  Fernando  Hospital,  226 
Screening,  isolation,  fumigation,  cir- 
cular on  Barbados,  274 
Ships  and  yellow  fever,  3,  77,  79,  80 
Slaves  and  disease,  82 

and  malaria,  82 
Smallpox,  atypical,  290 
Stegomyia  calopus,  names  of,  29 

calo2>us,  27,  52 

in  Europe,  78 

larvee  of,  31 

in  ships,  79,  80 


INDEX 


327 


Suez  Canal  and  malaria,  81 
Surinam,  115 


Tuberculosis,  St  Vincent,  173 
Trinidad,  225 


Tagus,  R.M.S.P.,  149 

Tortola,  10 

Tobago,  10,  14,  207 

Trade  routes  and  yellow  fever,  76 

Treves,  Sir  Frederick,  18,  149 

Trinidad,  10,  11,  12,  13,  47,  116,  117 

Anophelines  of,  209 

and  ankylostomiasis,  219,  220,  240 

antilarval  bye-laws,  66 

and  blackwater,  207 

difficulties  of  diagnosis,  201 

early  history  of  yellow  fever,  10, 11, 
12,  13,  187,  188 

entomologist,  208 

General  Board  of  Health,  214 

health  on  estates,  219 

health  progress,  187 

and  leprosy,  225 

and  malaria,  207,  219 

mortahty,  191 

mosquito  survey,  208 

number  of  cases  of  yellow  fever,  190 

origin  of  outbreak,  yellow  fever,  191 

and  plague,  225 

prosecutions,  67,  68 

recent  epidemic  yellow  fever,  116, 
117,  189 

sanitary  administration,  214,  215, 
216,  217 

sanitary  science  training,  211,  212, 
213 

sanitary  staff  of  Port  of  Spain,  216- 
218 

and  smallpox,  225 

Stegomyia  survey,  205 

teaching  of  hygiene,  213 

Town  Board,  215 

and  tuberculosis,  225 

and  Venezuela,  192,  201 

water-supply,  188 

and  yaws,  226 

yellow  fever  prophylaxis,  202 
Tuberculosis,  Grenada,  161 

British  Guiana,  246 


UmcH,  Mr  F.  W.,  208 
Uncinariasis  (see  Ankylostomiasis) 

Vaeicella,  290 
Venezuela,  115 

and  fevers,  197 

and  health  administration,  194 

health  of,  199 

and  Trinidad,  192,  201 

and  yellow  fever,  194,  196-201 

Wakes,  prevention  of,  269 
"Water-supply  and  yellow  fever,  34-36 
Weil's  disease,  96 
Windward  Islands,  9 

Yaewood,  Mr  Graham,  123 
Yaws  and  Grenada,  160 

and  St  Lucia,  185 

and  Trinidad,  226,  227 
Yellow  fever  and  Beauperthuy,  22 

and  Africa,  3 

and  Amazon,  115,  118,  119,  310 

and  Barbados,  3,  12,  13, 14,  84-121, 
268,  283 

and  British  Guiana,  16,  228,  231 

and  British  Honduras,  305 

and  Carthagena,  6 

causes  of,  20,  25,  26-28,  29,  30 

and  Central  America,  193,  194, 195 

and  clerical  co-operation,  43,  44 

and  climate,  21 

and  Cuba,  299,  300 

difficulties  of  diagnosis,  92,  93,  94, 
95 

and  Dominique,  101 

Dr  Hutson's  Report  on  St  Lucia 
and  Barbados,  270 

early  diagnosis,  130,  141 

early  history  of,  1,  2,  3 

education,  41,  45,  46 

and  Europe,  5 

fumigation,  138 

and  Georgetown,  11,  16,  17, 18 


328 


INDEX 


Yellow  fever  and  Grenada,  3,  12,  150, 

152,  153 
and  Guadeloupe,  2,  11 
and  Gulf  Stream,  20 
and  Havana,  6 
and  hospitals  isolation,  137 
incubation  period,  extrinsic,  28 

in  man,  27 

in  mosquito,  28 
intimidation,  101,  102,  103,  104 
and  Jamaica,  8,  9,  16,  302 
larval,  anti-,  laws,  54-75 
and  Latin  Republics,  309 
and  Leeward  Islands,  9 
and  Martinique,  115,  292,  293,  294 
mild  cases,  93 
and  Montserrat,  10 
and  Nassau,  15 
and  Nevis,  10 
notification,  tardy,  284 

early,  97,  98,  99,  100,  105 
periodicity,  107 
and  Porto  Rico,  299,  300 
prophylaxis,  32,  108,  154,  202,  237, 

295 
quarantine    precautions,   112,   114, 
139,  140,  183 


Yellow  fever,  race  incidence,  106 
recent  outbreaks,  189,  190,  191 
rules  for    dealing  with,  278,  279, 

280 
and  St  Domingo,  2 
and  St  Lucia,  13,  174,  175, 181,  182, 

140,  142 
and  St  Vincent  (1909  cases),  166 
and  St  Vincent,  13,  15,  116 
and  sea  mosquitos,  23 
season  of  outbreak,  108 
and  ships,  77,  78,  79 
source  of  outbreak,  112 
and  stagnant  water,  34-36 
and  Surinam,  115 
and  trade  routes,  76-83 
treatment  of,  281,  283 
and  Trinidad,  10,  11,  12,  13,  187, 

188,  116,  117 
and  Tobago,  10 
and  Tortola,  10 
and  United  States,  5 
~"and  Venezuela,  115,  194,  196-201 
and  water-supply,  188 
West  Indies,  3 
Windward  Islands,  9 
"  Yellow  jack,"  78 


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